Year: 2019
Type: article
Study design: Case Report
Abstract: Mentor: Christopher Bingcang Program: Otolaryngolgy Introduction: Laryngeal histoplasmosis is a rare entity, with <100 case reports in the literature. Patients with laryngeal involvement often report hoarseness, mucosal ulcerations, dysphagia, and odynophagia. Laryngeal lesions caused by histoplasmosis are highly variable in both location and appearance, and can be easily misdiagnosed as either malignancy, tuberculosis, or granulomatous diseases. Case description: We present a series of three cases of laryngeal histoplasmosis. All patients presented with new onset voice changes, odynophagia, and dysphagia. All patients were immunosuppressed secondary to treatment of medical co-morbidities with two treated for Crohn’s disease and one receiving chemotherapy for prostate cancer. Upon endoscopic evaluation, ulcerative lesions and thickening were found in all three patients. Those with Crohn’s disease had diffuse supraglottic disease, while the patient receiving chemotherapy had a unilateral true vocal fold lesion. These lesions were suspicious for malignancy and biopsies were obtained. Biopsies returned negative for malignancy. In one patient with Crohn’s, a biopsy was indeterminate, and subsequently developed a bowel perforation and was diagnosed with disseminated histoplasmosis on surgical pathology. One patient was diagnosed after fungal cultures grew Histoplasma at four weeks. Increased suspicion led to diagnosis via Gomori Methenamine Silver Stain in another. All patients were subsequently followed by infectious disease, started on antifungals, and symptoms resolved. Discussion: These cases illustrate the high index of suspicion required to make the diagnosis of laryngeal histoplasmosis, especially in the Midwestern United States. Diagnosis may be made quickly and cost-effectively with proper staining. Delayed diagnosis may lead to dissemination, increased morbidity, and mortality.
Authors: Blecha, Jonathan, Bingcang, Christopher, Oltman, Justin
Institution: University of Nebraska Medical Center
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W2995486142