Invasive primary aspergillosis of the larynx presenting as hoarseness and a chronic nonhealing laryngeal ulcer in an immunocompetent host: A rare entity

July 13, 2014
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Abstract

Primary aspergillosis usually affects the paranasal sinuses, orbit, ear, and lower respiratory tract. Laryngeal aspergillosis usually occurs as a result of secondary invasion from the tracheobronchial tree, more commonly in immunocompromised hosts. Primary laryngeal localization of Aspergillus infection is seldom encountered. We report the case of an immunocompetent 42-year-old man who presented with hoarseness and a laryngeal ulcer of fairly long duration. A malignancy was initially suspected clinically, but a laryngoscopic biopsy led to a diagnosis of invasive primary laryngeal aspergillosis. No other focus of aspergillosis was found on x-ray and computed tomography. After identification of Aspergillus niger on culture, inquiries revealed no exposure to steroids, cytotoxic drugs, or irradiation, and workups for malignancy, human immunodeficiency virus infection, tuberculosis, and diabetes were negative. Although isolated laryngeal involvement is rare, aspergillosis may be considered in the differential diagnosis of a chronic nonhealing laryngeal ulcer that is clinically suggestive of a malignancy, even in an immunocompetent host.

Introduction

Laryngeal aspergillosis is quite rare; it generally occurs secondary to severe and invasive aspergillosis of the lower respiratory tract.1,2 Laryngeal aspergillosis is more common in patients with a malignancy, immunodeficiency, diabetes, or terminal debilitating illness, as well as those with a history of exposure to steroids, cytotoxic drugs, or irradiation.3-8

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