Primary Aspergillosis of the Larynx.

Richard H Law ,Samuel A Reyes

doi:10.1155/2016/1234196

Richard H Law , Samuel A Reyes

Open Access

https://doi.org/10.1155/2016/1234196

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Abstract

Laryngeal aspergillosis is most commonly seen as a result of secondary invasion from the lungs and tracheobronchial tree in immunocompromised hosts. Primary aspergillosis of the larynx is, however, rare with few cases documented over the past fifty years. We report a case of a 73-year-old woman who presented with persistent hoarseness. She is a nonsmoker with a history of asthma and chronic bronchiectasis treated with bronchodilators, inhaled and oral corticosteroids, and nebulized tobramycin. Direct laryngoscopy with vocal cord stripping confirmed the diagnosis of invasive aspergillosis with no manifestations elsewhere. The patient was successfully treated with oral voriconazole with no signs of recurrence. Although several major risk factors contributing to the development of primary aspergillosis of the larynx have been discussed in the literature, there has been no mention of inhaled antibiotics causing this rare presentation to the best of our knowledge. We, therefore, highlight the use of inhaled tobramycin as a unique catalyst leading to the rapid onset of this rare presentation.

Highlights

Disseminated invasive aspergillosis is most commonly associated with immunocompromised states such as AIDS, malignancies, aplastic anemia, chemotherapy, radiation, immunosuppressants, and genetic disorders of the immune system [1]
She is a nonsmoker with a history of asthma and chronic bronchiectasis treated with inhaled ipratropium bromide/albuterol, oral prednisone, and an inhaled combination of budesonide and formoterol, prior to starting nebulized tobramycin
Inhaled tobramycin has never been mentioned as a factor contributing to this rare disease to date

Summary

Introduction

Disseminated invasive aspergillosis is most commonly associated with immunocompromised states such as AIDS, malignancies, aplastic anemia, chemotherapy, radiation, immunosuppressants, and genetic disorders of the immune system [1]. Aspergillus can cause localized/primary disease in relatively healthy patients with the external auditory canal, paranasal sinuses, and orbit being the most common sites affected [2, 4, 5, 7]. Primary aspergillosis of the larynx is, extremely rare when compared to the incidence of primary aspergillosis affecting other sites within the head and neck. As a result, this unique presentation may be mistaken for malignancy of the vocal folds initially. The exact mechanism of primary aspergillosis of the larynx is still unclear but is most likely multifactorial

Case Report

Discussion