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Table of Contents
CASE REPORT
Year : 2018  |  Volume : 8  |  Issue : 2  |  Page : 43-45

Primary aspergillosis of bilateral vocal cords in an immunocompetent individual


Department of Laryngology, Deenanath Mangeshkar Hospital and Research Centre, Pune, Maharashtra, India

Date of Web Publication24-Jul-2019

Correspondence Address:
Dr. Sachin Sharad Gandhi
Voice Clinic, Deenanath Mangeshkar Hospital, Pune, Maharashtra
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/jlv.JLV_20_18

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   Abstract 


Aspergillosis is an inflammatory fungal infection rarely affecting larynx. There are, invariably, certain risk factors which may predispose to fungal infections, such as immune deficiency states, use of inhaled or systemic steroids, and long and continuous use of antibiotics. Primary aspergillosis in an immunocompetent individual is very rare. A case report of such patient is presented in this article. Treatment with voriconazole led to complete resolution of aspergillosis.

Keywords: Aspergillosis, immunocompetent, leukoplakia


How to cite this article:
Gandhi SS, Shenoy SB. Primary aspergillosis of bilateral vocal cords in an immunocompetent individual. J Laryngol Voice 2018;8:43-5

How to cite this URL:
Gandhi SS, Shenoy SB. Primary aspergillosis of bilateral vocal cords in an immunocompetent individual. J Laryngol Voice [serial online] 2018 [cited 2019 Aug 26];8:43-5. Available from: http://www.laryngologyandvoice.org/text.asp?2018/8/2/43/263374




   Introduction Top


Aspergillosis is an inflammatory disease caused by infection with one of the species of fungi of the genus Aspergillus (Aspergillus fumigatus, Aspergillus niger, and Aspergillus flavus) and of the family Aspergillacea. Primary aspergillosis of the larynx in an immunocompetent patient is rare. There are, invariably, certain risk factors which may predispose to fungal infections, such as immune deficiency states, use of inhaled or systemic steroids, and long and continuous use of antibiotics.[1] Globally, <50 cases over a period of the last 50 years have been documented.[2] As this condition often mimics malignant or premalignant lesion, awareness of these fungal lesions is must while treating vocal fold leukoplakic patches.


   Case Report Top


A 65-year-old male patient presented to a voice clinic with progressive hoarseness of voice for about 1 month. There was no history of cough or dysphagia associated with it. The patient never smoked or consumed tobacco in any form. He did not have any co morbidities and was not on any long term medications. His videolaryngostroboscopy showed bilateral vocal fold leukoplakic patches in the mid-third with mobile cords [Figure 1]. Blood investigations and chest X-ray were normal. The patient underwent microlaryngoscopy and excision biopsy. The specimen was sent for histopathological examination, KOH mount, and fungal and aerobic culture. KOH mount showed moderate number of narrow hyaline septate, acutely branching fungal hyphae. In fungal culture, A. fumigatus was grown on Sabouraud dextrose agar. Histopathology reported as ulcerated and inflamed mucosa with colonization by Aspergillus species [Figure 2]. Tissue invasion or angioinvasion was not seen. Tablet voriconazole 200 mg BD given for 1 month showed complete resolution of lesions on follow-up [Figure 3]. His voice improved after treatment. Patient is followed up for 3 months post treatment and no recurrence of patch noted. Primary aspergillosis of the larynx in an immunocompetent patient is very rare.
Figure 1: Videolaryngostroboscopy showing leukoplakia of both cords

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Figure 2: Histopathology showing Aspergillus colonization in vocal cord biopsy

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Figure 3: Posttreatment videolaryngostroboscopy showing complete resolution

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   Discussion Top


A. fumigatus and A. niger are the most common species pathogenic for human. Aspergillus infection causes sinusitis, bronchitis, pulmonary aspergillosis, and laryngitis.[3] Aspergillosis of the larynx can be invasive or noninvasive. Aspergillus is recognized by circular, uniform caliber mycelium on section, septate hyphae, and occasional folds with dichotomous branching patterns in KOH mount.[4] The incidence of primary aspergillosis of the larynx is still exceedingly rare, with few cases documented over the past 50 years.[5],[6],[7]

Leukoplakic patch over vocal cords gives a suspicion to be premalignant or malignant lesion. However, if fungal infections considered in differential diagnosis of such cases, early diagnosis and better treatment can be given. KOH mount and fungal culture are the methods to diagnose aspergillosis. Histopathological examination helps in finding out invasion.

Antifungals such as voriconazole and itraconazole are used for the treatment of aspergillosis. In our case report of primary laryngeal aspergillosis presented with leukoplakia, a good suspicion and early treatment improved the voice of the patient. Treatment with voriconazole led to complete resolution of aspergillosis.


   Conclusion Top


Aspergillosis should be considered in differential diagnosis of isolated leukoplakia of the vocal cord. Early diagnosis and management of laryngeal aspergillosis can prevent progression of disease to invasive aspergillosis.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Florent M, Ajchenbaum-Cymbalista F, Amy C, Rio B, Molina T, Audouin J, et al. Dysphonia and dysphagia as primary manifestations of invasive aspergillosis. Eur J Clin Microbiol Infect Dis 2001;20:441-2.  Back to cited text no. 1
    
2.
Subramanya SH, Jillwin J, Rudramurthy SM, Rijal KC, Nayak N, Chakrabarti A, et al. Primary invasive laryngeal mycosis in an immunocompetent patient: A case report and clinico-epidemiological update. BMC Infect Dis 2018;18:323.  Back to cited text no. 2
    
3.
Dutta M, Jotdar A, Kundu S, Ghosh B, Mukhopadhyay S. Primary laryngeal aspergillosis in the immunocompetent state: A clinical update. Braz J Otorhinolaryngol 2017;83:228-34.  Back to cited text no. 3
    
4.
Jackson C, Jackson CL. Diseases and injuries of larynx. In: Thomson SC, editor. Diseases of the Nose and Throat. 2nd, 6th, ed. New York: Macmillan Co.; 1942. p. 567.  Back to cited text no. 4
    
5.
Sood VP, Daharwal A, Bahadur S. Primary aspergillosis of the larynx. Indian J Otolaryngol Head Neck Surg 1983;35:41.  Back to cited text no. 5
    
6.
Liu YC, Zhou SH, Ling L. Aetiological factors contributing to the development of primary laryngeal aspergillosis in immunocompetent patients. J Med Microbiol 2010;59:1250-3.  Back to cited text no. 6
    
7.
Doloi PK, Baruah DK, Goswami SC, Pathak GK. Primary aspergillosis of the larynx: A case report. Indian J Otolaryngol Head Neck Surg 2014;66:3268.  Back to cited text no. 7
    


    Figures

  [Figure 1], [Figure 2], [Figure 3]



 

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