Pulsed dye laser treatment of primary cryptococcal laryngitis: A novel approach to an uncommon disease

Ihenachor, Ezinne J.; Dewan, Karuna; Chhetri, Dinesh K.

doi:10.1016/j.amjoto.2016.08.007

Cited by 11 publications

(11 citation statements)

References 9 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%

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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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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“…Durch den in der Zahnheilkunde beim blauen Laser auftretenden, bekannten antimikrobiellen Effekt erweitert sich das Indikationsspektrum der photoangiolytischen Laser auf den leukoplakischen Biofilm [11][12][13]. Ebenso wird über viele positive Behandlungsergebnisse nach photoangiolytischer Laserung bei der Behandlung von Dysplasien und sogar bei T1-Karzinomen der Stimmlippe berichtet [14].…”

Section: Andere Läsionenunclassified

Photoangiolytische Laser in der Laryngologie

Heß¹,

Fleischer

2020

Laryngorhinootologie

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ZusammenfassungMit photoangiolytischen Lasern wie dem KTP (Kalium-Titanyl-Phosphat, 532 nm Wellenlänge) -Laser oder dem neuen „blauen“ Laser (445 nm Wellenlänge) können kleinste Gefäße innerhalb der Stimmlippen unter Schonung des darüberliegenden Epithels und der Lamina propria verödet werden. Dadurch kann jetzt noch besser der Forderung Rechnung getragen werden, bei der effektiven Behandlung von pathologischen Gewebeveränderungen, wie bspw. bei Papillomen, Ödemen, Polypen, Leukoplakien, Dysplasien und ektatischen Blutgefäßen, gleichzeitig die physiologische Schwingungsfähigkeit der Stimmlippe zu bewahren. Da das Laserlicht durch feinste Glasfasern in den Kehlkopf geleitet werden kann, sind schmerzfreie Eingriffe im Behandlungsstuhl mit indirekt transnasal eingeführten flexiblen Optiken (mit Arbeitskanal) wie auch Operationen in Vollnarkose während einer Mikrolaryngoskopie möglich. Ein neuer sog. „blauer“ Laser ermöglicht zusätzlich neben der Koagulation auch das Schneiden von Gewebe, dann meist in Mikrolaryngoskopie.

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“…Although we congratulate on the observation, correct diagnosis and management, we would like further discuss its implications, but particularly a more thoughtful review of previously reported cases of laryngeal cryptococcosis. Whilst we concord that Cryptococcus neoformans laryngitis is "uncommon", at least 21 cases, since 1975, have been reported in the scientific literature, located using Medline and Scopus (2)(3)(4)(5). Then, we have reviewed and synthesized them ( Table 1).…”

Section: Laryngeal Cryptococcosis; a Condition Reported In Renal Tranmentioning

confidence: 99%