Primary Histoplasmosis of Larynx: A Case Series and Review of Literature

Nishi Sonkhya,Mansi Faujdar,Shubha Gupta,Raghav Mehta,Divij Sonkhya

doi:10.4236/ijohns.2013.22012

Abstract

Objective: Aim of the study was to analyze 10 managed cases of Primary Histoplasmosis of Larynx, over a period of 10 years. Design: Retrospective, non-randomized, interventional case series. Patients and Method: This study was conducted in the Department of Otorhinolaryngology S.M.S Medical College from 2002 to 2011. The study consisted of evaluation of self-reported and referred patients who presented to ENT OPD and emergency. In all the cases a detailed history and clinical examination was done. All the patients underwent fiber optic laryngoscopy and subsequent direct laryngoscopy and biopsy. CT Scans were obtained for few cases. The study was a retrospective analysis of 10 treated cases. Main Outcome and Measures: Success of the treatment was defined as resolution of symptoms, differ-entiation from malignancy, no recurrence and regular follow up. Result: A total of 10 cases were managed between 2002 and 2011 and were reviewed. The main presentation was hoarseness of voice, with lesion simulating malignancy. Most common site of involvement was false cord and aryepiglottic fold (6 cases). Primary laryngeal Histoplasmosis was essentially a disease of adult males in all 10 cases. Treatment was exclusively medical with use of Itraconazole as drug of choice in 7 cases. Conclusion: Isolated laryngeal Histoplasmosis is a rare entity. Because of its simulation with malignancy it needs to be included in the differential diagnosis of neoplasm both benign and malignant. Our study clearly limits this kind of disease to adult males most commonly involving false cord and aryepiglottic fold in an endophytic pattern. Though it looks like cancer; biopsy confirms the diagnosis. The treatment is mainly medical with Itraconazole being the drug of choice.

Highlights

Histoplasmosis [1] is a disease caused by the fungus Histoplasma capsulatum
Histoplasmosis occurs throughout the world but is more common within endemic areas of North America, in fertile river valleys
The study consisted of evaluation of self-reported and referred patients who presented to ENT OPD and emergency

Summary

Introduction

Histoplasmosis ( known as “Cave disease,” “Darling’s disease,” “Ohio valley disease,” “Reticuloendotheliosis,” “Spelunker’s Lung” and Caver’s disease) [1] is a disease caused by the fungus Histoplasma capsulatum. Histoplasmosis occurs throughout the world but is more common within endemic areas of North America, in fertile river valleys. It can produce a spectrum of illness, from subclinical infection of lung to progressive disseminated diseases [2]. The vast majority of infected people are asymptomatic (have no apparent ill effects), or they experience symptoms so mild that they do not seek medical attention. Histoplasmosis can appear as a mild, flu-like respiretory illness and has a combination of symptoms, including malaise (a general ill feeling), fever, chest pain, dry or nonproductive cough, headache, loss of appetite, shortness of breath, joint and muscle pains, chills, and hoarseness. A chest X-ray can reveal distinct markings on an infected person’s lungs

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