Images in ID — What's the Diagnosis? Persistent Hoarseness in a Former Smoker

Dangol, Gulshan Man Singh; Brine, Patrick; Wilkins, Charles E.; Maharjan, S. B.; Gemmel, David

doi:10.1097/ipc.0000000000000557

Cited by 3 publications

(1 citation statement)

References 19 publications

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“…Review of the current literature, performed by Wong et al 3 and including the other reported on PubMed, Google Scholar, SCOPUS, and Web of Science, [5][6][7][8][9][10][11] suggests an evolution of the presentation of laryngeal cryptococcosis. Including this presented case, 29 unique cases have been described.…”

Section: Discussionmentioning

confidence: 99%

Laryngeal Cryptococcosis: An Evolving Rare Clinical Entity

Worrall

Lerner

Naunheim

et al. 2019

Ann Otol Rhinol Laryngol

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Objectives: Describe the demographics and clinical manifestations of laryngeal cryptococcosis. Develop a simple approach to the diagnostic workup and treatment of localized laryngeal cryptococcal infection. Methods: A new case of laryngeal cryptococcosis encountered at our institution is presented and placed in context of the literature surrounding prior reported cases. PubMed, Google Scholar, SCOPUS, and Web of Science were queried from inception to August 2018 with the terms Larynx or Laryngeal and Cryptococcosis or Cryptococcus by two independent reviewers for English-language cases of cryptococcal infection of the larynx. Results: Twenty-nine unique cases of laryngeal cryptococcosis were identified. Median age at presentation was 65 years old. All patients presented with persistent or progressive hoarseness. Lesions were predominantly on the true vocal cords (79%), 38% associated with an adherent white exudate or leukoplakia. A minority (28%) was immunocompromised, and of the remaining immunocompetent hosts, 67% were found to be using nebulized or inhaled corticosteroids (ICS) prior to infection. Diagnosis should be suspected in patients with chronic laryngitis or mass lesions with the aforementioned risk factors. Diagnosis was made by histopathology with cryptococcal yeasts identified on methenamine silver (55%) and/or mucicarmine stains (48%). Serum cryptococcal antigen testing was unreliable (sensitivity = 39%). The mainstay of effective treatment was prolonged oral Fluconazole therapy, with two cases of laser therapy ablation of residual lesions. Improvement in voice and vocal lesions varied from weeks to months. Conclusions: Laryngeal cryptococcosis is a rare cause of persistent hoarseness, which appears to be clinically evolving and more frequently affecting immunocompetent hosts chronically using nebulized or inhaled corticosteroids. Laryngeal cryptococcal infection is readily treatable with prolonged oral antifungals once biopsy and histopathological stains confirm the diagnosis.

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Section: Discussionmentioning

confidence: 99%

Laryngeal Cryptococcosis: An Evolving Rare Clinical Entity

Worrall

Lerner

Naunheim

et al. 2019

Ann Otol Rhinol Laryngol

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Cryptococcal Laryngitis: Three Cases Managed With Potassium-Titanyl-Phosphate Laser and Literature Review

Lamprell,

Broadhurst

2023

Journal of Voice

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Cryptococcal Laryngitis

Myer

File²,

Kellermier

et al. 2022

Infect Dis Clin Pract

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Introduction Cryptococcus neoformans infects immunocompromised and occasionally noncompromised individuals. Cryptococcus neoformans can cause primary localized laryngitis often associated with inhaled corticosteroid therapy. We report a woman with cryptococcal laryngitis who presented with hoarseness and resultant difficulty singing in her church choir. Case Description A 75-year-old asthmatic woman had a 1-year history of hoarseness and difficulty singing in her church choir. The medications are as follows: inhaled mometasone/formoterol, inhaled montelukast, and pantoprazole. She cleans her gutters without mask protection. The examination showed only hoarseness of voice. Strobovideolaryngoscopy revealed nodule on right true vocal cord. Biopsy revealed budding yeasts with a mucicarmine-positive capsule compatible with Cryptococcus species. She was treated with oral fluconazole 400 mg daily and her voice dramatically improved at 6-week follow-up. Discussion Laryngeal cryptococcosis is a localized form of cryptococcal disease. It was first reported in 1975. This is the 33rd reported case of cryptococcal laryngitis. We herein review the literature.

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Images in ID — What's the Diagnosis? Persistent Hoarseness in a Former Smoker

Cited by 3 publications

References 19 publications

Laryngeal Cryptococcosis: An Evolving Rare Clinical Entity

Laryngeal Cryptococcosis: An Evolving Rare Clinical Entity

Cryptococcal Laryngitis: Three Cases Managed With Potassium-Titanyl-Phosphate Laser and Literature Review

Cryptococcal Laryngitis

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