Primary Laryngeal Aspergillosis in the Immunocompetent Patient

Abstract

Introduction Fungal infections of the larynx are truly rare in immunocompetent people with only a handful of cases reported in the past five decades. Here we present a case series of 3 people (from 2019 to 2021), with no comorbid conditions, who presented with primary laryngeal aspergillosis. Materials and Methods Three patients with primary aspergillosis of the larynx were seen in the ENT outpatient department from 2019 to 2021, aged between 40-50 years of which two were females and one patient was a male. We describe the clinical presentation of each patient. Discussion Aspergillosis of the larynx usually occurs secondary to bronchopulmonary infections in the immunocompromised. The usual etiological factors include prolonged use of inhaled steroids, cytotoxic drugs, radiotherapy, smoking, mucosal injury, and antibiotic abuse. Persistent hoarseness of voice is the most common presenting symptom. Video laryngoscopy reveals erythema, oedema, hyperkeratosis, adherent white plaques, shallow ulcerations, and grey or white pseudo membrane formation over the vocal cords. 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. Conclusion Primary aspergillosis of the larynx has occurred more frequently in recent times. Aspergillosis of the larynx can often mimic malignant or premalignant lesions. Persistent hoarseness of voice not responding to treatment should also raise a suspicion of fungal laryngitis, in the clinician and relatively simple treatment be done before significant morbidity occurs.