Isolated Laryngeal Coccidioidomycosis - A Case Report and Review of the Literature

Abstract

Coccidioidomycosis involving the larynx is a rare occurrence which seems to present with non-specific upper airway symptoms. The diagnosis is made by tissue biopsy and the treatment is usually fluconazole for 6-12 months depending on the clinical presentation. In unusual presentations of laryngeal problems clinicians should consider Coccidioidomycosis, especially in endemic regions.We present a 59-year-old Hispanic female resident of West Texas who presented with symptoms of hoarseness, sore throat, and low-grade fevers for 2-3 months. She had been evaluated by her primary care physician who had treated her with several courses of antibiotics including quinolones, azithromycin, and cephalosporins. Because of the persistence of her symptoms she was sent to an otolaryngologist. On examination her temperature was 98.4 F, blood pressure was 124/78 mm Hg, and pulse 78 bpm. Laryngoscope revealed a soft tissue mass along the left side of the airway just above the vocal cords. No cervical lymphadenopathy was noted. The rest of the examination was unremarkable.

Laryngeal coccidioidomycosis in adults: systematic review of the literature and a case report

“…In the period of review indicated, 8 articles were found, with 10 cases, in which there was a distribution by sex of 7 men and 3 women, the mean age was 49.3 years, with an age less than 34 years and greater than 75 years 6,7,12,13,[16][17][18][19] . The ten cases reported were from the southern region of the United States, which borders our state of Sonora in the north.…”

“…In all presented cases, there was a diversity of manifestations that do not give it specific characteristics. The most frequent associated symptom was dysphonia (hoarseness) in 8 patients 6,7,12,13,16-18 (80%) followed by dysphagia (5 patients, 50%) 7,12,13,17 , weight loss 7,12,18,19 and cough 7,16,17,19 (4 patients each, 40%), fever 6,16,18 and odynophagia 7,12,19 (3 patients each, 30%), sore throat 6,19 (2 patients), haemoptysis 18,19 (2 patients), dyspnea 13,18 (2 patients), adenopathy 16 (1 patient). It can manifest as a chronic process of long evolution until debuting with the formation of abscesses.…”

“…The most frequent areas of the larynx involved were the epiglottis (3 patients) 7,12,17 , vocal cords (3 patients) 6,18,19 , the ventricular bands (2 patients) 17,19 , the aryepiglottic folds (2 patients) 7,17 , arytenoids, the glottic lumen and the pyriform sinuses (1 patient each) 7,17 .…”

“…The most common presentation includes symptoms of chronic fatigue, malaise and productive cough; episodes of occasional arthralgias are also common with a primary lung source 5 . The risk factors associated with severe or disseminated infections are immunosuppressed states, such as: AIDS, solid organ transplant recipients [6][7][8] , lymphomas, or long-term steroid use 9 . In 60% of coccidioidomycosis cases, lung infection may be asymptomatic or mild and may occur within an incubation period of 8 to 30 days 10,11 .…”

“…In 60% of coccidioidomycosis cases, lung infection may be asymptomatic or mild and may occur within an incubation period of 8 to 30 days 10,11 . While the vast majority of coccidioidomycosis infections have a primary pulmonary origin, primary coccidioidomycosis of the larynx is a very rare and unusual presentation 6 . In the lung, parenchyma arthroconidia take the form of spherules containing endospores triggering a local immune response 7 .…”