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de Oliveira VF, Taborda M, Catarina MBS, Kruschewsky WLL, Rapozo MM, da Rocha TQ, Pagliari C, Magri ASGK, Magri MMC, Soto MN. Clinical and immunological features of laryngeal cryptococcosis. Rev Inst Med Trop Sao Paulo 2024; 66:e40. [PMID: 39052027 PMCID: PMC11251512 DOI: 10.1590/s1678-9946202466040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Accepted: 05/08/2024] [Indexed: 07/27/2024] Open
Abstract
The literature holds few descriptions on immune response findings for laryngeal cryptococcosis. Immunology has been more extensively described in cases involving the central nervous system and the lungs, although many of these studies were conducted in animal models. We aimed to analyze the clinical and immunological characteristics of three patients with laryngeal cryptococcosis. We observed a weak participation of the innate immune response, whereas adaptive immunity showed the predominance of a Th2-type response over a Th1-type response. Most cases occur in male older adults with immunosuppressive conditions, of which HIV infection was absent. Hoarseness configured the main symptom. We found a disease that was restricted to the larynx and possibly the lungs by contiguity. Patients with hoarseness and lesions in nasal endoscopy should be investigated for cryptococcosis by a biopsy of the larynx, including with negative serum cryptococcal antigen. The immunological aspects of our findings of laryngeal involvement resembled those in the most commonly affected systems.
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Affiliation(s)
- Vítor Falcão de Oliveira
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
| | - Mariane Taborda
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
| | - Mateus Bach Santa Catarina
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas Departamento de Patologia, São Paulo, São Paulo, Brazil
| | - Wdson Luis Lima Kruschewsky
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
| | - Marjorie Marini Rapozo
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
| | - Thais Queiroz da Rocha
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas Departamento de Patologia, São Paulo, São Paulo, Brazil
| | - Carla Pagliari
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas Departamento de Patologia, São Paulo, São Paulo, Brazil
| | - Adriana Satie Gonçalves Kono Magri
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
| | - Marcello Mihailenko Chaves Magri
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Departamento de Moléstias Infecciosas e Parasitárias, São Paulo, São Paulo, Brazil
| | - Miriam Nacagami Soto
- Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas Departamento de Patologia, São Paulo, São Paulo, Brazil
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Zainal Abidin MR, Syed Hamzah Al-Yahya SN, Mansor M, Abdul Rahim N. Vocal fold cryptococcal granuloma: A rare occurrence in immunocompetent patient. Int J Surg Case Rep 2024; 115:109228. [PMID: 38199018 PMCID: PMC10824779 DOI: 10.1016/j.ijscr.2024.109228] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Revised: 12/30/2023] [Accepted: 01/03/2024] [Indexed: 01/12/2024] Open
Abstract
INTRODUCTION AND IMPORTANCE Cryptoccous infection or cryptococcosis is a severe opportunistic infection occurring mainly in immunocompromised patients. Laryngeal cryptococcus infection is rare. In an immunocompetent patient, inhaled corticosteroid was reported to be a possible risk factor. CASE PRESENTATION We discuss a case of right vocal fold cryptococcus infection in a healthy, immunocompetent 71-year-old man with no history of inhaled corticosteroid, presented with hoarseness and intermittent aspiration symptom for 1 year duration. Further examination showed right anterior vocal fold mass with presence of right vallecular cyst. CLINICAL DISCUSSION Patient underwent direct laryngoscopy, excision of right vocal fold mass and marsupialization of vallecular cyst. Histopathological examination revealed cryptococcal infection. Patient subsequently treated with oral fluconazole 400 mg daily for 6 months. To date, hoarseness and aspiration symptoms have resolved. CONCLUSION We are sharing our experience in managing laryngeal cryptococcus infection in an immunocompetent patient where the associated risk factors discussed in previous literatures are absent.
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Affiliation(s)
| | | | - Masaany Mansor
- Department of Otorhinolaryngology, Hospital Al-Sultan Abdullah UiTM, Bandar Puncak Alam, Selangor, Malaysia; Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia.
| | - Norazila Abdul Rahim
- Department of Otorhinolaryngology, Hospital Al-Sultan Abdullah UiTM, Bandar Puncak Alam, Selangor, Malaysia; Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia.
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Lamprell L, Broadhurst M. Cryptococcal Laryngitis: Three Cases Managed With Potassium-Titanyl-Phosphate Laser and Literature Review. J Voice 2023:S0892-1997(23)00267-9. [PMID: 37833110 DOI: 10.1016/j.jvoice.2023.08.020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 08/20/2023] [Accepted: 08/21/2023] [Indexed: 10/15/2023]
Abstract
OBJECTIVES To present three case reports of cryptococcal laryngitis managed with potassium-titanyl-phosphate (KTP) laser, where only one case managed with KTP laser has previously been published to date to our knowledge. Further, to systematically review the medical literature and describe the epidemiology, clinical assessment, treatment, and prognosis of laryngeal cryptococcosis. METHODS The PubMed, Embase, and OVID MEDLINE databases were searched using the terms "cryptococcal laryngitis" or "cryptococcus" and "larynx or laryngeal." RESULTS Thirty-eight cases were identified. The median age was 65 years with a 1 male:1.2 female ratio. Thirty-six cases (95%) presented with hoarseness. Twenty-one cases (55%) were systemically immunosuppressed and 19 (50%) were taking an inhaled corticosteroid. This paper lists the five clinical features (i. white exudate or lesion; ii. exophytic, verrucous or tumor-like mass; iii. diffuse erythema; iv. mucosal irregularity; v. thickened vocal fold) and four pathologic features or tests (i. Grocott Gomori Methenamine stain; ii. Mucicarmine stain; iii. fungal or yeast organisms; iv. fungal culture) that encompass 97% of cases of cryptococcal laryngitis reported in the medical literature. In 34 cases (89%), antifungal therapy was given. Four cases (11%) had excisional biopsy and 11 (29%) received combined surgery and medical therapy. There was uncomplicated resolution in 24 cases (63%). CONCLUSION Cryptococcal laryngitis is a rare cause of hoarseness that may be mistaken for malignancy or may be a manifestation of disseminated cryptococcal infection or underlying immunosuppression. Clinicians should be aware of the diagnostic features of cryptococcal laryngitis to facilitate diagnosis and treatment to prevent complicated disease and overly aggressive treatment.
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Affiliation(s)
- Laura Lamprell
- Queensland Centre for Otolaryngology and Voice, Level 7, 457 Wickham Terrace, Spring Hill, QLD 4000, Australia.
| | - Matthew Broadhurst
- Queensland Centre for Otolaryngology and Voice, Level 7, 457 Wickham Terrace, Spring Hill, QLD 4000, Australia
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Fay MJ, Byrnes C, Pillarisetti N, Fox-Lewis A, McSharry B, Blincoe A, Barber C, Sinclair J, Best E. Invasive multifocal cryptococcal airway disease in a teenager with hypogammaglobulinemia. Pediatr Pulmonol 2021; 56:4069-4071. [PMID: 34637604 DOI: 10.1002/ppul.25691] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 09/08/2021] [Accepted: 09/21/2021] [Indexed: 11/07/2022]
Affiliation(s)
- Michael-John Fay
- Department of Paediatric Infectious Diseases, Starship Hospital, Auckland, New Zealand
| | - Cass Byrnes
- Respiratory Services, Starship Hospital, Auckland, New Zealand.,Faculty of Medical and Health Sciences, University of Auckland, New Zealand
| | | | - Andrew Fox-Lewis
- Department of Microbiology, LabPlus, Auckland City Hospital, Auckland, New Zealand
| | - Brent McSharry
- Paediatric Intensive Care Unit, Starship Hospital, Auckland, New Zealand
| | - Annaliesse Blincoe
- Department of Paediatric Immunology and Allergy, Starship Hospital, Auckland, New Zealand
| | - Colin Barber
- Department of Otorhinolaryngology, Starship Hospital, Auckland, New Zealand
| | - Jan Sinclair
- Department of Paediatric Immunology and Allergy, Starship Hospital, Auckland, New Zealand
| | - Emma Best
- Department of Paediatric Infectious Diseases, Starship Hospital, Auckland, New Zealand.,Faculty of Medical and Health Sciences, University of Auckland, New Zealand
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Haught E, Roberts C, McChesney J. Cryptococcal Anterior Glottic Web from Disseminated Infection Presenting as Confusion: A Case Report. Ann Otol Rhinol Laryngol 2020; 130:211-214. [PMID: 32627566 DOI: 10.1177/0003489420937036] [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: 11/17/2022]
Abstract
OBJECTIVES To educate healthcare providers on Cryptococcus neoformans as a novel cause of glottic webs especially in an immunocompromised patient and discuss recurrence of the glottic web. This case also emphasizes the importance of a comprehensive patient evaluation in cases such as this, as laryngeal involvement in this case was only a portion of the patient's disease burden. METHODS An extensive review of the patient's clinical course was assessed including patient presentation, diagnostic techniques, medical and surgical treatment, and complications. RESULTS Prolonged Fluconazole therapy and two excisions of the glottic web, the second with keel placement, was an effective treatment course for our patient. CONCLUSION Cryptococcal glottic webs are rare, and this case report demonstrates successful treatment in one such case with operative intervention following medical management of disseminated disease.
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Affiliation(s)
- Erica Haught
- West Virginia University School of Medicine, Morgantown, WV, USA
| | - Christopher Roberts
- West Virginia University Department of Otolaryngology, Head and Neck Surgery, Morgantown, WV, USA
| | - Jason McChesney
- West Virginia University Department of Otolaryngology, Head and Neck Surgery, Morgantown, WV, USA
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