Primary Glottic Aspergillosis in an Immunocompetent Host - A Diagnostic Challenge

Abstract

Laryngeal aspergillosis is an uncommon fungal infection. Primary involvement of the larynx is particularly rare. Aspergillus infection of the larynx most often occurs as a secondary manifestation of infection elsewhere in the respiratory tract. However, isolated primary laryngeal disease can occur, as demonstrated in the present case. The infection may affect the vocal folds alone or extend to other laryngeal subsites Its clinical appearance can closely resemble a malignant or premalignant lesion. Recognition of this rare condition is therefore important, as confirmation of the diagnosis may prevent unnecessary extensive surgical intervention. Treatment with appropriate antifungal therapy, together with correction of identifiable predisposing factors, is generally associated with a favourable response. Primary laryngeal aspergillosis should consequently be considered among the differential diagnoses of suspicious laryngeal lesions, especially in patients without obvious immunosuppression. Here, we present a case of primary aspergillosis of the larynx in a 42-year-old immunocompetent male patient who was cured by oral Itraconazole.

Cases of aspergillosis of the larynx are very rare. Like other cases of mycosis, the larynx is generally involved secondarily by aspergillosis. In fact, the larynx is only involved in advanced stages of broncho-pulmonary aspergillosis. In a few extremely rare cases, however, the larynx happens to be the primary site of lesion. It is an opportunistic fungal infection affecting immunocompromised patients. In an immunocompromised patient, aspergillus infection is usually necrotising, invasive, and associated with poor prognosis. In immunocompetent patients, laryngeal aspergillosis may represent colonisation rather than invasion. The diagnosis of aspergillosis is important as the presenting symptoms are suspicious of malignant laryngeal disease. A patient with laryngeal aspergillosis can present with hoarseness, throat pain, dysphagia, severe paroxysmal cough, tachypnea or even stridor. We report a case of primary Aspergillus infection confined to the vocal cords and highlight the clinical manifestations, diagnosis and management.