Cryptococcosis in the Vocal Cords, Trachea, and Bronchi

Abstract

Laryngeal and endobronchial cryptococcosis are rare conditions, and to our knowledge, there have been only 23 cases of laryngeal cryptococcosis, and 18 cases of endobronchial cryptococcosis previously reported in the English literature. We herein report an extremely rare case of cryptococcosis with simultaneous laryngeal and endobronchial involvement. This case highlights the importance of paying close attention to possible occurrence of cryptococcosis of the airway tract in patients with asthma treated with high-dose inhaled corticosteroids.

Endobronchial cryptococcosis with bronchial stenosis in a patient with severe asthma treated with inhaled corticosteroids: A case report

“…To our knowledge, only one prior case of endobronchial cryptococcosis without pulmonary lesions has been reported. [1][2][3] We suspected that ICS put the patient at risk of endobronchial cryptococcosis because his status was not defined as systemically immunocompromised, although cryptococcosis can occur in immunocompetent patients. The patient had no other risk factors including exposure to Cryptococcus spp., haematological malignancy, diabetes mellitus, or systemic immunosuppressive therapy.…”

“…Inhaled corticosteroids (ICS) are known causes of occasional cryptococcosis of the larynx but not the bronchi. 2,3 Here, we report a case of endobronchial cryptococcosis with bronchial stenosis in a patient with severe asthma treated with ICS.…”

“…Cryptococcosis typically manifests as pulmonary lesions caused by fungal spores or poorly encapsulated yeast inhalation and deposition on pulmonary alveoli, 1 and rarely presents as endobronchial lesions. 2 Important risk factors for cryptococcosis include cellular immunodeficiency, including human immunodeficiency virus (HIV) infection and/or acquired immunodeficiency syndrome, hematologic malignancies, and systemic immunosuppressive therapy, including corticosteroids. 1 Nevertheless, immunocompetent patients can develop cryptococcosis.…”

Invasive multifocal cryptococcal airway disease in a teenager with hypogammaglobulinemia

“…Endoscopic findings include laryngeal edema, erythematous mucosa, leukoplakia, exudate, and distinct lesions. These lesions have had various descriptions including “warty,” “verrucous,” “budding,” or “friable.” All previous cases were managed with either surgical debridement, systemic antifungals, or both 3,4 …”

“…All previous cases were managed with either surgical debridement, systemic antifungals, or both. 3,4 Pathogenic cryptococci have characteristic virulence factors, most notably polysaccharide capsules which facilitate immune evasion. In vitro studies demonstrate the requirement of antibody or complement-mediated opsonization of the capsule for successful phagocytosis and destruction of cryptococci.…”