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Wei H, Wang W, Bai Q, Li Z. Primary Vocal Cord Aspergillosis Can Involve the Trachea and Bronchus in Previously Healthy Patients: A Case Report. EAR, NOSE & THROAT JOURNAL 2024:1455613241249097. [PMID: 38676418 DOI: 10.1177/01455613241249097] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/28/2024] Open
Abstract
Primary vocal cord aspergillosis is extremely rare in immunocompetent individuals, in whom lesions are mainly confined to the larynx, with the possibility of tracheal and bronchial infection largely ignored. In this article, we present a case of primary vocal cord aspergillosis involving the trachea and bronchus in a previously healthy 55-year-old woman. Our case highlights that vocal cord aspergillosis can involve the trachea and bronchus and that laryngoscopy alone may be insufficient to secure a comprehensive diagnosis in healthy patients presenting with hoarseness, pharyngalgia, and normal chest radiography. Furthermore, influenza B virus infection may be a risk factor for this rare disease.
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Affiliation(s)
- Huasheng Wei
- Department of Respiratory and Critical Care Medicine, Dazhou Central Hospital, Dazhou, China
| | - Weilin Wang
- Department of Respiratory and Critical Care Medicine, Dazhou Central Hospital, Dazhou, China
| | - Qinwen Bai
- Department of Respiratory and Critical Care Medicine, Dazhou Central Hospital, Dazhou, China
| | - Zhihui Li
- Department of Respiratory and Critical Care Medicine, Dazhou Central Hospital, Dazhou, China
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Sheth MC, Paul RR, Mathews SS, Albert RR. Isolated Aspergillus Laryngitis: Spectrum, Management, and Review of Literature. J Voice 2020; 36:880.e13-880.e19. [PMID: 33004228 DOI: 10.1016/j.jvoice.2020.09.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Revised: 09/04/2020] [Accepted: 09/08/2020] [Indexed: 11/30/2022]
Abstract
PURPOSE Isolated aspergillus laryngitis is rare and often diagnosed after surgical excision or biopsy for a suspected premalignant or malignant pathology. Unlike other systemic or localized aspergillosis, there are no specific guidelines for isolated laryngeal aspergillosis. Our experience of dealing with a wide variety of isolated laryngeal aspergillosis showed that this entity is very responsive to medical therapy, making extensive debridement (as often carried out in surgically accessible aspergillosis) unnecessary as it would invariably lead to long-term dysphonia. MATERIALS AND METHODS A retrospective analysis of all cases of isolated aspergillus laryngitis that presented to our hospital over the past 5 years was carried out. All patients with confirmed histopathological diagnosis of aspergillus infection were included. RESULTS Twelve patients (five males and seven females) aged 28-54 years, who were diagnosed with aspergillus laryngitis presented with dysphonia. The most common involved site was the true vocal cords. All patients underwent cautious biopsies either in the operating theatre or in-office using a channeled fiber-optic laryngoscope. On histopathological examination, eight had invasive aspergillus infection while others showed variety of noninvasive involvement including colonization of cysts and carcinoma in situ. The most common species isolated was Aspergillus fumigatus. Appropriate antifungal chemotherapy was prescribed after ruling out systemic involvement. None of the patients showed recurrence or residual lesions on follow-up and reported significantly improved voice. CONCLUSIONS This study highlights the wide spectrum of presentation of isolated aspergillus laryngitis with Aspergillus fumigatus being the most common organism isolated. Even the invasive variant is a medically treatable condition with voriconazole being the drug of choice. The importance of cautious biopsies and resections for voice preservation is also emphasized. To our knowledge, this is the largest report on isolated aspergillus laryngitis.
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Affiliation(s)
- Meet Chetan Sheth
- Department of ENT Unit -5, Christian Medical College, Vellore, India.
| | - Roshna Rose Paul
- Department of ENT Unit -5, Christian Medical College, Vellore, India
| | | | - Rita Ruby Albert
- Department of ENT Unit -5, Christian Medical College, Vellore, India
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Rajmohan K, Khan ID, Kapoor U, Hashmi SA, Gupta RM, Sen S, Nair GL, Singh KK, Tandel K, Malik M. PRIMARY LARYNGEAL ASPERGILLOSIS IN AN IMMUNOCOMPETENT PATIENT. INTERNATIONAL JOURNAL OF MEDICINE AND MEDICAL RESEARCH 2020. [DOI: 10.11603/ijmmr.2413-6077.2019.2.10456] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background. Aspergillus is an inherently ubiquitous, weakly pathogenic fungus causing opportunistic infections. It is very rarely localized in the larynx, although laryngeal Aspergillosis may develop in the immunocompromised patients including those with leukaemia and severe aplastic anaemia.
Objective. The aim of the research was to explore the primary laryngeal Aspergillosis in an immunocompetent patient thru a case report.
Methods. A case report of primary laryngeal Aspergillosis in an immunocompetent patient is presented.
Results. A male patient of 40 years old, presenting with chronic worsening hoarseness, was found to have a smooth, white spheroid submucosal growth on left vocal cord with preserved bilateral cord movements on videostroboscopy. Histopathological examination of vocal cord growth revealed squamous epithelium containing septate hyphae with acute angle dichotomous branching pattern consistent with Aspergillus. Voice improved after a four-week course of oral itraconazole 200 mg/day. Post therapy follow up of 24 months was unremarkable.
Conclusions. Primary laryngeal Aspergillosis develops in the immunocompetent patients. Iatrogenic, vocal abuse, occupation and lifestyle factors may be contributory. Optimal diagnosis and management mandates a high index of suspicion.
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Chouksey S, Thulasidas P. A Rare Case of Vocal Cord Aspergillosis. Indian J Otolaryngol Head Neck Surg 2019; 71:868-871. [PMID: 31742084 DOI: 10.1007/s12070-019-01626-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2018] [Accepted: 02/19/2019] [Indexed: 11/28/2022] Open
Abstract
Primary aspergillosis of larynx is very rare. Till now only 28 cases of isolated laryngeal aspergillosis are documented in the English literature. In the field of otorhinolaryngology, aspergillosis most frequently affects external auditory canal or nasal sinuses and larynx is usually secondarily involved. It usually affects the patients with immunocompromised state and usually presents with hoarseness of voice. Laryngeal lesions usually mimics malignancy, so accurate diagnosis with direct laryngoscopy and biopsy is needed for further management. As these lesions responds very well to antifungal therapy, early diagnosis and starting antifungal therapy is important. Here we are presenting a case report of 67 years old male with aspergillosis of vocal folds without any immunodeficiency.
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Affiliation(s)
| | - P Thulasidas
- Sinus and Nose Hospital, Mylapore, Chennai, India
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Wisniowski-Yáñez A, Ramírez-Anguiano J, Rosado-Canto R, Valdivia-Cayoja A, Pérez-Gutiérrez T, Cuellar-Rodriguez J. Aspergillus infection of the larynx in a solid organ transplant recipient. Transpl Infect Dis 2018; 20:e12900. [PMID: 29668122 DOI: 10.1111/tid.12900] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Revised: 02/28/2018] [Accepted: 03/17/2018] [Indexed: 11/27/2022]
Abstract
Primary laryngeal aspergillosis is a rare condition. Only a few cases have been reported in the past years. Most of them have been reported in healthy patients or with a mild immunocompromised state. We report a case of primary laryngeal aspergillosis in a solid organ transplant recipient (SOT), an infection not previously described in this population; we reviewed the published literature in all populations.
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Affiliation(s)
- Andrea Wisniowski-Yáñez
- Department of Infectious Diseases, Mineral Metabolism and Transplant, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jaqueline Ramírez-Anguiano
- Department of Otorhinolaryngology, Mineral Metabolism and Transplant, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Rodrigo Rosado-Canto
- Department of Nephrology, Mineral Metabolism and Transplant, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Adolfo Valdivia-Cayoja
- Department of Infectious Diseases, Mineral Metabolism and Transplant, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Teresa Pérez-Gutiérrez
- Department of Infectious Diseases, Mineral Metabolism and Transplant, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
| | - Jennifer Cuellar-Rodriguez
- Department of Infectious Diseases, Mineral Metabolism and Transplant, Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán, Mexico City, Mexico
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Swiss T, Cervantes SS, Hinni M, Lott DG. Invasive fungal laryngopharyngitis resulting in laryngeal destruction with complete laryngotracheal separation: Report of a case. EAR, NOSE & THROAT JOURNAL 2017; 96:E33-E36. [PMID: 28122110 DOI: 10.1177/014556131709600105] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
As the treatment of hematopoietic cancers evolves, otolaryngologists will see a higher incidence of opportunistic infections. We discuss a case of invasive fungal disease that invaded the larynx, pharynx, trachea, and pulmonary parenchyma after chemotherapy. The patient, a 46-year-old woman, presented 1 week after undergoing induction chemotherapy. Her initial symptoms were odynophagia and dysphagia. Despite encouraging findings on physical examination, her health rapidly declined and she required an urgent tracheotomy and multiple operations to address spreading necrosis. Because of her inability to heal, she was not a candidate for laryngectomy, so she was treated with conservative management. The patient was then lost to follow-up, but she returned 5 months later with laryngeal destruction and a complete laryngotracheal separation. While noninvasive fungal laryngitis is routinely encountered, its invasive counterpart is rare. The literature demonstrates that some cases completely resolve with medical therapy alone but that surgery is necessary in others. We recommend surgical debridement of all necrotic tissue.
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Affiliation(s)
- Tyler Swiss
- Midwestern University-Arizona College of Osteopathic Medicine, 19555 N. 59th Ave., Glendale, AZ 85308, USA.
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Saha A, Saha K, Chatterjee U. Primary aspergillosis of vocal cord: Long-term inhalational steroid use can be the miscreant. Biomed J 2016; 38:550-3. [PMID: 27013456 PMCID: PMC6138373 DOI: 10.1016/j.bj.2015.09.001] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2015] [Accepted: 09/14/2015] [Indexed: 11/15/2022] Open
Abstract
Primary laryngeal aspergillosis is extremely rare, especially in an immunocompetent host. It is commonly found as a part of systemic infection in immunocompromised patients. A case of vocal cord aspergillosis with no systemic extension in an immunocompetent patient on long-term steroid metered dose inhaler (MDI) is presented here, because of its rarity. The present case is a 28-year-old asthmatic female who was on inhalational steroid for 8 years, presented with sudden onset of severe dysphonia for 5 days. Fiberoptic laryngoscopy demonstrated whitish plaque involving right vocal cord, clinically suggestive of fungal laryngitis. Microlaryngeal laser surgery was performed with stripping of the plaque. Histopathology demonstrated ulcerated hyperplastic squamous epithelium with masses of fungal hyphae, which was confirmed to be Aspergillus species on fungal culture. This rare but serious adverse effect of long-term steroid MDI use must be kept in mind while treating an asthmatic patient. We also present a brief review of literature of laryngeal aspergillosis.
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Affiliation(s)
- Arpita Saha
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
| | - Kaushik Saha
- Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India
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Ran Y, Lu Y, Cao L, Li C, Dai Y, Yang H, Liu Y, Bai H, Zhang C. Primary laryngeal aspergillosis related to oral sex? A case report and review of the literature. Med Mycol Case Rep 2012; 2:1-3. [PMID: 24432202 DOI: 10.1016/j.mmcr.2012.11.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2012] [Revised: 11/17/2012] [Accepted: 11/26/2012] [Indexed: 02/05/2023] Open
Abstract
Primary laryngeal aspergillosis is an extremely rare opportunistic infection, especially in an immunocompetent host. Here we report a case of a 23-year-old female with a history of oral sex, which may be a suspected predisposing factor in this immunocompetent patient.
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Affiliation(s)
- Yuping Ran
- Department of Dermatovenerology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yao Lu
- Department of Dermatovenerology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Ludan Cao
- Department of Dermatovenerology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Conghui Li
- Department of Dermatovenerology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yaling Dai
- Department of Medical Laboratory, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Hanjun Yang
- Department of Dermatovenerology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Yonghui Liu
- Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Haoru Bai
- Department of Otolaryngology, West China Hospital, Sichuan University, Chengdu 610041, China
| | - Chaoliang Zhang
- Department of State Key Laboratory of Oral Diseases, Sichuan University, Chengdu 610041, China
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Liu YC, Zhou SH, Ling L. Aetiological factors contributing to the development of primary laryngeal aspergillosis in immunocompetent patients. J Med Microbiol 2010; 59:1250-1253. [PMID: 20576752 DOI: 10.1099/jmm.0.021634-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Primary laryngeal aspergillosis is extremely rare, especially in an immunocompetent host. It is commonly found as part of a systemic infection involving the respiratory system in immunocompromised people. Two cases of laryngeal aspergillosis with no systemic extension and no generalized immune deficiency are presented here. We report what is to the best of our knowledge only the second case of Aspergillus infection in a vocal cord cyst. Aspergillus species were identified in tissue sections and confirmed by PCR studies. We present a literature review of laryngeal aspergillosis cases and discuss predisposing factors, clinical presentation, histopathology, PCR, diagnosis and treatment of Aspergillus laryngitis. The known aetiological causes of the disease are increasing and include iatrogenic factors, vocal abuse, vocal-fold cysts and occupational factors, and immunocompetent patients are susceptible to these predisposing factors.
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Affiliation(s)
- Yong-Cai Liu
- Department of Otolaryngology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, PR China
| | - Shui-Hong Zhou
- Department of Otolaryngology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, PR China
| | - Ling Ling
- Department of Otolaryngology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, PR China
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Bibliography. Current world literature. Laryngology and bronchoesophagology. Curr Opin Otolaryngol Head Neck Surg 2007; 15:417-24. [PMID: 17986882 DOI: 10.1097/moo.0b013e3282f3532f] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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