Atypical Laryngeal Infections: Localized Lesions from Unusual Organisms May Simulate Malignancy

Abstract

Objective: The identification of rare sources of laryngeal infection in immunocompetent patients. Recovered organisms were Mycobacterium tuberculosis (laryngeal tuberculosis [LTB]), Mycobacterium fortuitum (laryngeal Mycobacterium fortuitum [LMF]), and Blastomyces dermatiditis (laryngeal blastomycosis [LB]). Method: Single institution retrospective case series of three patients over a 2.5-year period and review of the literature on laryngeal infections by three atypical organisms. Results: Three patients presented with hoarseness and cough; one additionally had throat pain (LTB). Indirect laryngoscopy demonstrated diffuse laryngeal ulceration (LTB, LMF) and an exophytic, contiguous glottic mass (LB). Direct microlaryngoscopic biopsies and cultures established the diagnoses, including a frozen section in one case (LB), which prevented a simultaneously planned surgical resection. Appropriate antimicrobial therapy yielded dramatic laryngeal and corresponding vocal improvement, for which we provide unique photo and audio documentation. In the last 10 years, fewer than 500 cases of LTB have been reported in the English language medical literature, principally outside the United States. To date, there have been reports of only 34 LB and no cases of LMF. Conclusion: Atypical infections of the larynx may be localized and mimic laryngeal cancer on endoscopy. Tissue examination as well as microbiologic samples are diagnostic and complementary.

Tuberculose laryngée isolée de l´adulte: localisation extra pulmonaire exceptionnelle: a case clinique

“…Notre patient, bien qu´il fût asymptomatique au cours de son hospitalisation, avait un important œdème des voies aériennes supérieures, ayant pu mettre en jeu son pronostic vital. Les lésions constatées à la laryngoscopie suggèrent souvent un cancer du larynx, d´autant plus qu´il n´existe pas de preuve bactériologique de tuberculose laryngée [ 12 , 13 ]. En effet, la TL peut se manifester, macroscopiquement, par un œdème, une hyperémie, des ulcérations, un nodule ou une masse exophytique.…”

Nontuberculous Mycobacterial Infection of Larynx and Cervical Trachea

“…1 While NTM infection most commonly involves the pulmonary system, prior studies have documented head and neck involvement. [2][3][4][5][6][7][8] Laryngeal NTM infections are exceedingly rare. Failure to consider an atypical mycobacterial infection in the differential diagnosis when presented with an ulcerative, exophytic mass may result in insufficient tissue evaluation, delayed diagnosis, and disease progression.…”

Right Vocal Cord Paralysis Caused by Histoplasmosis: A Case Report

“…3,4 These signs and symptoms are often difficult to distinguish from a malignancy and, due to this, histoplasmosis-related findings are frequently misdiagnosed as small cell carcinoma or tuberculosis. 2-5…”

“…3,4 These signs and symptoms are often difficult to distinguish from a malignancy and, due to this, histoplasmosis-related findings are frequently misdiagnosed as small cell carcinoma or tuberculosis. [2][3][4][5] The causes of vocal cord paralysis are varied, including laryngeal trauma, inflammatory processes, and vascular conditions. 6,7 Iatrogenic vocal cord paralysis occurs due to recurrent laryngeal nerve injury after surgical procedures, specifically thyroidectomy, carotid endarterectomy, and anterior approaches to the cervical spine, among others.…”