Postoperative Actinomycotic Infection of the Larynx

Abstract

surface of the left arytenoid (Fig. I). This was removed, exposing a 1.5 ern long sinus tract lined with necrotic material and leading to the cricoarytenoid joint (Fig. 2). Biopsy studies of the tract were interpreted to show granulation tissue with marked acute inflammation. Gram staining of this material disclosed focal gram-positive cocci colonies (Fig. 3). Cultures were taken and subsequently grew moderate Staphylococcus aureus and sparse Pseudomonas aeruginosa . Following laryngoscopy the patient's condition improved rapidly and she was discharged from the hospital. A follow-up examination 2 weeks later revealed mild left arytenoid edema and slight limitation of left vocal cord motion. Indirect laryngoscopic studies several months later were entirely normal. DISCUSSIONThis patient's symptomatology is characteristic of cricoarytenoid arthritis as described by Montgomery et al." and Montgomery. 4 Her history of rheumatoid arthritis led to a presumptive diagnosis of rheumatoid cricoarytenoid arthritis; however, the physical findings and elevated white count indicated an infectious etiology. It is known that articulations affected by rheumatoid arthritis are more susceptible to septic arthritis than are normal articulations." The contribution of rheumatoid disease in this case is difficult to determine, but the Case Reports absence of chronic inflammatory changes argues tn favor of a predominantly bacterial arthritis. CONCLUSIONA case of cricoarytenoid arthritis in a rheumatic patient is presented. Clinical and laboratory data indicate this to be a septic arthritis of the cricoarytenoid joint. Although infectious cricoarytenoid arthritis is mentioned in several texts, there are no reported cases in the recent literature.

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“…Although our patient was female, a male predominance of laryngeal actinomycosis exists in the literature (86.7%) [32][33][34][35][36]. This is not different that the prevalence of pulmonary actinomycosis.…”

Laryngeal Actinomycosis

“…Most of the cases reported occurred in patients who had previously undergone radiotherapy for laryngeal cancer. 4,5 The radiotherapyinduced alterations of the mucosa, and in particular thrombosis of small blood vessels and the consequent tissue hypoxia, probably facilitate the overgrowth of anaerobic micro-organisms such as Actinomycetes. 1 The differential diagnosis from areas of radionecrosis is essential.…”

“…Actinomycosis of the larynx is very rare; indeed only about 10 cases have been reported in the literature so far. [1][2][3][4][5] We present a case of actinomycosis that developed in the epiglottis.…”

Laryngeal Actinomycosis in an Immunocompromised Patient

“…2 Rarely, cases have been reported in which actinomycosis affects the larynx primarily. [4][5][6][7][8][9][10][11][12][13][14][15][16][17] Here, we present the case of laryngeal actinomycosis that developed in an immunocompromised patient with chronic lymphocytic leukemia (CLL).…”