Histoplasmosis of the Larynx

Abstract

A teamster, aged 41, became hoarse in May 1941. The hoarseness increased and at the end of four months severe cough, stridor and dyspnea were present on exertion, followed later by dysphagia, pain deep in the ears and generalized weakness. There was a loss in weight of 20 pounds (9.1 Kg.) during this period.When first seen at Barnes Hospital in January 1942 (seven and a half months after the onset of the illness), the patient appeared poorly nourished; he was unable to speak above a whisper and was in mild distress, due to inspiratory stridor.The epiglottis was thick, nodular and pale. It was tilted in a position preventing indirect examination of the larynx and encroached on the airway. Direct examination showed the whole interior of the larynx to be white and nodular. The false and true cords were involved to such an extent as to be entirely obliterated. The glottic chink was converted into an irregularly rounded tube.There was a daily rise in temperature of about 1 degree (F.). A presumptive diagnosis of keratosis of the larynx with carcinomatous change was made.With use of the Lynch suspension, most of the epiglottis was amputated and tracheotomy performed.Microscopic sections showed generalized keratosis with a greatly thickened tunica propria, infiltrated with plasma cells, lymphocytes and numerous multinucleated giant cells ( fig. 1). Within the giant cells were oval bodies, about 3 microns in diameter and possessing a central nuclear body ( fig. 2) and an outer thick retractile membrane. Dr. Morris Moore identified the organism as Histoplasma capsulatum.Treatment consisted of daily intravenous injections of 5 cc. of fuadin (an antimony preparation) for one week, followed by two weeks of rest and then another week of fuadin injections. No effect on the larynx was noted.Fractional irradiation of the larynx was given, but this therapy was stopped after twelve days because of uncontrollable pain in the ears and throat.At the time this report is made there are a proliferative lesion of the skin about the tracheotomy wound, an ulcération on the knee and a large amount of granulomatous tissue in the trachea and the main bronchi, which on one occasion neces¬ sitated bronchoscopy to prevent suffocation. Microscopic sections of tissue from these sites showed histoplasmosis.

Laryngeal inflammation mimicking laryngeal carcinoma

“…Other not so uncommon conditions causing chronic laryngeal infections are, Klebsiella rhinoscleromatis (Amoils and Shindo, 1996), higher bacteria such as Nocardia and Actinomyces species (Nelson and Tybor, 1992;Shaheen and Ellis, 1993), tuberculosis, leprosy and a variety of fungi. It is mainly the fungi such as Candida albicans (Hicks and Peters, 1982), blastomycosis (Suen et al, 1980;Payne and Koopmann, 1984), histoplasmosis (Donegan and Wood, 1984), and aspergillosis (Kheir et al, 1983;Benson-Mitchell et al, 1994), which give rise to granulomatous conditions closely resembling malignancy. This resemblance is not only on clinical grounds, but can also give rise to histolological dilemma; biopsy of the lesion is the corner stone of all the investigations.…”

The “forgotten zone”: Acquired disorders of the trachea in adults

“…Later, these lesions ulcerate and may resemble squamous cell carcinoma. 35 Histoplasmosis may cause external compression of central airways due to granulomatous lesions or calcified massive mediastinal lymph nodes, which may erode into adjacent airways.…”