Invasive Fungal Laryngopharyngitis Resulting in Laryngeal Destruction with Complete Laryngotracheal Separation: Report of a Case

Abstract

As the treatment of hematopoietic cancers evolves, otolaryngologists will see a higher incidence of opportunistic infections. We discuss a case of invasive fungal disease that invaded the larynx, pharynx, trachea, and pulmonary parenchyma after chemotherapy. The patient, a 46-year-old woman, presented 1 week after undergoing induction chemotherapy. Her initial symptoms were odynophagia and dysphagia. Despite encouraging findings on physical examination, her health rapidly declined and she required an urgent tracheotomy and multiple operations to address spreading necrosis. Because of her inability to heal, she was not a candidate for laryngectomy, so she was treated with conservative management. The patient was then lost to follow-up, but she returned 5 months later with laryngeal destruction and a complete laryngotracheal separation. While noninvasive fungal laryngitis is routinely encountered, its invasive counterpart is rare. The literature demonstrates that some cases completely resolve with medical therapy alone but that surgery is necessary in others. We recommend surgical debridement of all necrotic tissue.

Invasive fungal pharyngitis in a pediatric bone marrow transplant patient

“…The most studied site of invasive fungal infection remains sinonasal, but other sites have also been described, including the larynx, tracheobronchial tree, 2,3 thyroid, periorbital region, and adenoids 4,5 . To our knowledge, this is the first description of invasive fungal pharyngitis in a pediatric patient, and the second report of a patient with invasive fungal pharyngitis 6 …”

“…4,5 To our knowledge, this is the first description of invasive fungal pharyngitis in a pediatric patient, and the second report of a patient with invasive fungal pharyngitis. 6 The treatment strategy for invasive fungal disease is immediate aggressive surgical debridement and broad antifungal therapy. Patients who have diabetes undergo surgical resection, younger age, and have an ANC > 500/mcL have an improved prognosis compared to those unable to undergo surgery in invasive fungal sinusitis.…”

Case Report: Sudden Fatal Hemorrhage in Ulcerative Fungal Laryngotracheitis—A Pediatric Case Report

“…Revising the literature, ulcerative disruption of respiratory tract, descending from invasive Aspergillus laryngotracheal infection, are reported in adults [e.g., (9,10,14,20,25,(29)(30)(31)(32)(33)(34)(35)(36)(37)(38)(39)(40)(41)(42)(43)(44)(45)(46)] and in adolescents (15 and 17 years old) (47,48) but not in pediatric patients. According to our knowledge, only Barnes et al (49) and Athanassiadou et al (50) described Aspergillus laryngotracheobronchitis in children (6 and 2 years old) affected by acute lymphocytic leukemia; however, in these cases, the characterizing elements included plaques and necrotic cells, whereas ulcerative lesions were not reported.…”

“…In that case, the perforation was successfully repaired and resolved using a pedicle muscular flap ( latissimus dorsi ) and temporary airway stenting. Additionally, Swiss et al ( 44 ) reported about an invasive Aspergillus laryngopharyngitis affecting an immunocompromised woman (history of myelodysplastic syndrome and acute myelogenous leukemia) and leading to autolaryngectomy: laryngeal destruction up to complete laryngotracheal separation were observed. The patient survived by aggressive antifungal therapy and surgical debridement.…”