Primary Laryngeal Aspergillosis in an Immunocompetent Host

Abstract

Introduction
 Aspergillosis of Larynx is very rare and may present with symptoms suspicious of malignancy. Prevention of dissemination warrants early diagnosis. It is found mainly in Immunocompromised patients and is usually necrotizing, invasive with disseminated systemic infection, associated with poor prognosis. In Immunocompetent patients it is extremely rare and may present as colonization associated with excellent prognosis.
 Case Report
 A 43 year old male patient presented with hoarseness of voice for about 3 months with whitish irregular lesion that involved the anterior 1/3 of both the vocal cords. A cheesy material was found covering indurated lesion of both the vocal cords, intraoperatively. Stripping of mucosa over vocal cords was done and cheesy material collected and sent for HPE which revealed Aspergillus hyphae overlying Mild dysplastic changes. Following diagnosis the patient was followed up with oral dosages of Itraconazole.
 Discussion
 The primary Aspergillosis of larynx is extremely rare. Involvement is always secondary to immunocompromised states like AIDS, malignancy, Diabetes, etc. This was a rare case in Immunocompetent patient.
 Management constitute removal of the vocal cord lesions during biopsy. Amphotericin B is first-line agent for this infection, however aerosolised and liposomal amphotericin B offer effective dosing with less toxicity. Newer antifungal Itraconazole may produce more reliable results.

Primary Laryngeal Aspergillosis in the Immunocompetent Patient

“…Early diagnosis of laryngeal aspergillosis prevents dissemination of infection. 6 Video laryngoscopy reveals erythema, oedema, hyperkeratosis, adherent white plaques, shallow ulcerations, and grey or white pseudo membrane formation over the vocal cords. [1] Definitive diagnosis is done by the demonstration of hyphae either by KOH staining, culture in Sabouraud Dextrose Agar at 28 degrees Celsius, or tissue biopsy.…”

Natural Compounds for Preventing Ear, Nose, and Throat-Related Oral Infections

“…Hence, Aspergillus spp. first causes rhinosinusitis and broncho-pulmonary infections that may further spread to the skin, orbits, nose, larynx, and palate [ 44 , 45 , 46 ]. Tissue invasion is uncommon in immunocompetent individuals, but life-threatening complications can occur in patients with HIV infection, hematological malignancies, diabetes mellitus, or drug-induced immunosuppressive states [ 20 , 43 , 44 , 46 ].…”

“…first causes rhinosinusitis and broncho-pulmonary infections that may further spread to the skin, orbits, nose, larynx, and palate [ 44 , 45 , 46 ]. Tissue invasion is uncommon in immunocompetent individuals, but life-threatening complications can occur in patients with HIV infection, hematological malignancies, diabetes mellitus, or drug-induced immunosuppressive states [ 20 , 43 , 44 , 46 ]. This happens because in healthy people acquiring this infection the inhaled fungus is destroyed by macrophages and neutrophils, whereas in immunocompromised patients microorganisms may pass through without being intercepted due to neutropenia or neutrophil dysfunction [ 44 , 45 ].…”

“…However, their effect in immunocompromised individuals is not very clear. In addition to antifungal therapy, surgical debridement may be involved [ 43 , 46 ].…”