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Cryptococcus neoformans is ubiquitous fungus commonly found in the environment, particularly in soil, usually in association with pigeon and other bird droppings (1,2). Its clinical impact depends mostly on the immune state of the host (1,2). In AIDS, cancers and transplant recipients, this pathogen can cause primary pulmonary infections or disseminated, including the central nervous system (CNS), among other locations, which can include the larynx (1,2). In this setting, we have read with interesting the recent case report by Sandhu et al (2), where they described a case of cryptococcosis in a renal allograft recipient that clinically presented with hoarseness of voice and mimicked laryngeal carcinoma on examination. Although we congratulate on the observation, correct diagnosis and management, we would like further discuss its implications, but particularly a more thoughtful review of previously reported cases of laryngeal cryptococcosis. Whilst we concord that Cryptococcus neoformans laryngitis is “uncommon”, at least 21 cases, since 1975, have been reported in the scientific literature, located using Medline and Scopus (2-5). Then, we have reviewed and synthesized them (Table 1). Of them, the median age was 64 years-old (range 30-87 years-old), 57% were male, 90% presented hoarseness, only one was a renal transplant recipient, but six were receiving corticosteroids, five had chronic obstructive pulmonary disease, five with asthma, three with HIV infection/AIDS and two with diabetes. Four of them were exposed to birds, particularly pigeons (Table 1). In 18 out of the 21 cases, diagnosis was based mostly in biopsy including other complementary diagnostic tools. Regarding the treatment, 71% received fluconazole (in 4 of them by 6 months), 14% itraconazole and 10% amphotericin B. In 4 cases (19%) no antifungal pharmacological treatment was used (Table 1). Then, the case reported by Sandhu et al (2), was very young, with similar risk factors to those reported before (e.g. use of corticosteroids and the transplant), being diagnosed by the biopsy from laryngeal mass lesion and treated with fluconazole. As they, we agree of the utmost need for biopsy confirmation in these cases, but particularly also the call for more research on therapeutic options on these types of cryptococcosis, as e.g. there are no randomized, prospective trials of antifungal treatment of solid organ transplant recipients. In these and other immunosuppressed patients (e.g. HIV/AIDS), therapy would be difficult to choose, especially when dissemination to the CNS occurs (6).

Laryngeal cryptococcosis; a condition reported in renal transplant recipients and other immunosuppressed patients