Fungal laryngitis causing airway compromise in post irradiated patient

Abstract

Fungal laryngeal infection is commonly seen in immunocompromised individuals, and can mimic other laryngeal diseases like gastroesophageal reflux disease, granulomatous disease, leucoplakia and carcinoma. Therefore, it is important for correct initial diagnosis and treatment to avoid morbid consequences. We have reported a patient with laryngeal candidiasis who was previously diagnosed with laryngeal cancer and treated by concurrent chemoradiation therapy, presented with shortness of breath and stridor, requiring an emergency tracheostomy. Laryngoscopy examination revealed the presence of irregular mucosa at the posterior 2/3 of the left vocal cord extending to the left false cord and biopsy taken. Histopathological examination revealed necrotic tissue with colonies of bacteria and Actinomyces, and closer examination revealed fungal organisms exhibiting round, budding structures along with branching hyphae of varying sizes. Special histochemistry with Gomori Methenamine. Silver (GMS) and periodic acid-Schiff (PAS) stains confirmed the presence of fungal bodies. Tissue for culture and sensitivity grew Candida albicans, and the patient treated with IV fluconazole and discharge home with oral fluconazole. Post-treatment follow-up laryngoscopy examination revealed normal laryngeal mucosa with no evidence of fungal bodies or tumours recurrence. A conclusion can be made that diagnosis of a patient with fungal laryngitis requires early detection and treatment, as misdiagnosis or delay in treatment may result in further impairment to the anatomical and functional properties of the larynx. Invasive fungal infection can mimic or hide underlying concomitant laryngeal malignancies. Therefore, performing a biopsy during initial presentation allows the exclusion of underlying malignancy and further progression of the malignancy.