An Unusual Cause of Laryngotracheobronchitis

Menon, Vidthiya; Jo, Helen; Corte, Peter; Lee, A.S.; Wignall, Anthony; Reddel, Helen K.

doi:10.1016/j.clinmicnews.2016.05.001

Cited by 2 publications

(2 citation statements)

References 33 publications

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“…Review of the current literature, performed by Wong et al 3 and including the other reported on PubMed, Google Scholar, SCOPUS, and Web of Science, [5][6][7][8][9][10][11] suggests an evolution of the presentation of laryngeal cryptococcosis. Including this presented case, 29 unique cases have been described.…”

Section: Discussionmentioning

confidence: 99%

“…Among these cases, the only reported side effects were 2 instances of nausea in those receiving 400 mg total of Fluconazole daily, which resolved after the dose was halved. 9 Oral fluconazole therapy duration varied significantly with 39% of cases having less than 3 months of treatment, 52% receiving 3 to 6 months of therapy, and 9% requiring more than 6 months of treatment. In 2 instances, a 585 nm pulsed dye or a potassium titanyl phosphate (KTP) laser was used to ablate residual cryptococcal lesions.…”

Section: Discussionmentioning

confidence: 99%

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Laryngeal Cryptococcosis: An Evolving Rare Clinical Entity

Worrall

Lerner

Naunheim

et al. 2019

Ann Otol Rhinol Laryngol

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Objectives: Describe the demographics and clinical manifestations of laryngeal cryptococcosis. Develop a simple approach to the diagnostic workup and treatment of localized laryngeal cryptococcal infection. Methods: A new case of laryngeal cryptococcosis encountered at our institution is presented and placed in context of the literature surrounding prior reported cases. PubMed, Google Scholar, SCOPUS, and Web of Science were queried from inception to August 2018 with the terms Larynx or Laryngeal and Cryptococcosis or Cryptococcus by two independent reviewers for English-language cases of cryptococcal infection of the larynx. Results: Twenty-nine unique cases of laryngeal cryptococcosis were identified. Median age at presentation was 65 years old. All patients presented with persistent or progressive hoarseness. Lesions were predominantly on the true vocal cords (79%), 38% associated with an adherent white exudate or leukoplakia. A minority (28%) was immunocompromised, and of the remaining immunocompetent hosts, 67% were found to be using nebulized or inhaled corticosteroids (ICS) prior to infection. Diagnosis should be suspected in patients with chronic laryngitis or mass lesions with the aforementioned risk factors. Diagnosis was made by histopathology with cryptococcal yeasts identified on methenamine silver (55%) and/or mucicarmine stains (48%). Serum cryptococcal antigen testing was unreliable (sensitivity = 39%). The mainstay of effective treatment was prolonged oral Fluconazole therapy, with two cases of laser therapy ablation of residual lesions. Improvement in voice and vocal lesions varied from weeks to months. Conclusions: Laryngeal cryptococcosis is a rare cause of persistent hoarseness, which appears to be clinically evolving and more frequently affecting immunocompetent hosts chronically using nebulized or inhaled corticosteroids. Laryngeal cryptococcal infection is readily treatable with prolonged oral antifungals once biopsy and histopathological stains confirm the diagnosis.

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