Cryptococcal laryngitis: An uncommon presentation of a common pathogen

Atiya, Yahya; Masege, S D

doi:10.7196/samjnew.8779

Cited by 4 publications

(5 citation statements)

References 3 publications

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“…Laryngeal cryptococcosis is a rare disease, which might be caused by hematogenous spread from lungs or direct deposit by inhaled aerosolized organisms [7]. To our knowledge, less than 30 cases of laryngeal cryptococcosis have been reported [4,8,9] since first described in 1975 [10]. Among cases in which species of Cryptococcus was reported, only one case was caused by C. gattii [7], and the rest were by C. neoformans [4,8,9].…”

Section: Discussionmentioning

confidence: 99%

“…To our knowledge, less than 30 cases of laryngeal cryptococcosis have been reported [4,8,9] since first described in 1975 [10]. Among cases in which species of Cryptococcus was reported, only one case was caused by C. gattii [7], and the rest were by C. neoformans [4,8,9]. The most recent case reports review of laryngeal cryptococcosis by Wong et al points towards inhaled corticosteroid use, particularly high dose as the most significant risk factor with 45% (10/22) of corticosteroid use by cases [4].…”

Section: Discussionmentioning

confidence: 99%

“…Except for the patients who were lost to follow-up, all patients including four HIV patients were cured of laryngeal cryptococcosis [4]. All patients had hoarseness or dysphonia [4,8,9]. Rarity of disease, variable nonspecific laryngeal endoscopic findings, and need for tissue biopsy are challenging conditions to make a correct diagnosis [9].…”

Section: Discussionmentioning

confidence: 99%

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Risk factors of laryngeal cryptococcosis: A case report

Quintero

Trachuk

Lerner

et al. 2019

Medical Mycology Case Reports

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Cryptococcal infections are acquired by inhalation of encapsulated yeast cells or basidiospores. While Cryptococcus has a propensity to invade the lungs and central nervous system, other sites can be affected. Laryngeal cryptococcosis is rare with less than 30 previously reported cases, which commonly occurred in apparently immunocompetent hosts on inhaled corticosteroids. We present a case of laryngeal cryptococcosis with a long-term inhaled corticosteroid use, co-infection of pulmonary Mycobacterium avium-intracellulare , and mannose-binding lectin deficiency.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Risk factors of laryngeal cryptococcosis: A case report

Quintero

Trachuk

Lerner

et al. 2019

Medical Mycology Case Reports

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“…Of these 29 cases, only 8 (28%) were systemically immunosuppressed: 5 with human immunodeficiency virus (HIV) infection, 10,12-15 2 renal transplant recipients, 5,7 and 1 case of systemic immunosuppression for rheumatoid arthritis and inflammatory bowel disease. 2 The remaining cases were immunocompetent, and of those, 67% had chronic inhaled corticosteroid use (Table 1).…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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