Blastomycosis of the head and neck

Rucci, J.; Eisinger, Gregory; Miranda-Gomez, G.; Nguyen, Jimmy

doi:10.1016/j.amjoto.2013.12.013

Cited by 28 publications

(24 citation statements)

References 49 publications

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“…The most commonly involved extrapulmonary sites are the skin, bones, genitourinary tract, and central nervous system. Mucocutaneous disease is easily mistaken for carcinoma because the lesions tend to rapidly develop, appear as well-circumscribed verrucous or pustular lesions with irregular heaped-up borders and purple-red discoloration, are commonly ulcerated, and bleed easily (3)(4)(5).…”

Section: Fig 2 (A and B)mentioning

confidence: 99%

“…To our knowledge, this is the first reported case of blastomycosis associated with a prosthetic laryngeal implant. Primary laryngeal blastomycosis, although relatively rare, is the most common site of head and neck involvement (5). Unlike most extrapulmonary manifestations of the disease, laryngeal blastomycosis is presumed to result from direct inoculation of the laryngeal mucosa via inhalation.…”

Section: Fig 2 (A and B)mentioning

confidence: 99%

“…Unlike most extrapulmonary manifestations of the disease, laryngeal blastomycosis is presumed to result from direct inoculation of the laryngeal mucosa via inhalation. It invariably presents as worsening dysphonia and an exophytic polypoid mass on either the true or false vocal cords (5). Biopsy specimens show pseudoepitheliomatous hyperplasia with atypia, which may be easily mistaken for malignancy, particularly if no special staining (i.e., GMS, periodic acid-Schiff stain [PAS]) is performed.…”

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confidence: 99%

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The Brief Case: Laryngeal Blastomycosis Involving a Vocal Cord Implant

2019

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A 54-year-old woman from southern Ohio presents with progressive dysphonia and a chronic nonhealing neck wound. She has a history of Hodgkin's lymphoma treated with external beam radiation of the neck 30 years ago. Beginning 3 to 4 years ago, she began to experience dysphonia and was diagnosed with left true vocal cord paralysis, thought to be a late complication of her radiation. She subsequently underwent left medial thyroplasty and placement of a laryngeal prosthetic, which improved her symptoms. A few months before her current presentation, however, her dysphonia returned. Her surgeon suspected displacement of the laryngeal prosthesis as the cause, so the original implant was replaced. Approximately 5 weeks postoperatively, she developed induration, erythema, and tenderness of the anterior neck surgical incision. Empiric cephalexin provided initial improvement, but she soon developed wound dehiscence with purulent drainage. A course of amoxicillin-clavulanate offered no improvement. Over the following weeks, the wound alternated between actively draining and crusting over, resulting in a 2-cm ulcer. The patient was referred to otolaryngology shortly after these episodes. Direct laryngoscopy at her initial visit was notable for a stiff and polypoid left true vocal fold, and a trial of clindamycin followed by oral prednisone failed to relieve her symptoms. Computed tomography imaging demonstrated mild biapical scarring of the lungs and the left vocal fold implant with overlying soft tissue inflammation extending to the skin; no fistulous tract was seen. She was admitted for debridement of the neck lesions and biopsy sampling of the vocal fold mass; grossly, the lesion was exophytic and friable, involving the anterior 50% of the true vocal cord extending from superior to medial. Biopsy specimens of the mass and the surgical wound site revealed ulcerated squamous mucosa with chronic granulomatous inflammation, reactive epithelial changes, and numerous round 5-to 10-m refractile yeast forms with broad-based budding that were poorly stained by hematoxylin and eosin (H&E) but were Gomori methenamine silver (GMS) positive, suggestive of Blastomyces yeast cells (Fig. 1A and B). She underwent a second, more extensive debridement and removal of the new laryngeal implant, with the sebsequent operative report noting a fistulous tract extending from the chronic ulcer to an area of the left thyroid ala bordering the area of the implanted prosthetic. Tissue fungal cultures were positive for growth after 2 weeks of incubation, with cottony white colonies on both Sabouraud and brain heart infusion agar slants (Fig. 2A). Lactophenol cotton blue staining of a slide culture preparation demonstrated septate hyphae with smooth round conidia arising terminally on short lateral conidiophores in a characteristic "lollipop-on-astick" arrangement (Fig. 2B), suggestive of Blastomyces dermatitidis/gilchristii. This was subsequently confirmed by a Blastomyces-specific DNA probe (AccuProbe,

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Section: Fig 2 (A and B)mentioning

confidence: 99%

Section: Fig 2 (A and B)mentioning

confidence: 99%

Section: Fig 2 (A and B)mentioning

confidence: 99%

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The Brief Case: Laryngeal Blastomycosis Involving a Vocal Cord Implant

2019

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“…Blastomycosis is a rare cause of disease in the head and neck, with fewer than 100 cases published. Previous case series and reviews suggest that the most common otolaryngologic sites of involvement are the skin, larynx, and oral cavity . Presentation can be highly variable, and diagnosis can be challenging, particularly in the absence of identifiable pulmonary disease .…”

Section: Introductionmentioning

confidence: 99%

“…Symptoms of laryngeal blastomycosis may be limited to hoarseness or may include cough, throat pain, dyspnea, and dysphagia. Endoscopy typically reveals a polypoid mass or friable mucosa, and nearly all reported cases describe evaluation with direct laryngoscopy and biopsy . Treatment with systemic antifungal medication is typically successful when disease is limited to the larynx.…”

Section: Introductionmentioning

confidence: 99%

Primary Laryngeal Blastomycosis: Diagnostic Challenges and Advances in a Rare Cause of Laryngitis

et al. 2019

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Blastomyces dermatitidis is a fungal organism endemic to the central and southern United States and capable of causing numerous diseases. Primary blastomycosis of the larynx is a rare clinical entity with a limited number of reported cases in the literature. Diagnosis is challenging as a result of nonspecific physical exam findings, difficulty of histopathologic detection and culture, and need for operative laryngeal biopsy for definitive identification. Molecular and serologic testing is not widely available. The authors present a case of laryngeal blastomycosis, the diagnosis of which was facilitated by in-office biopsy, and discuss diagnostic challenges.

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