Primary Cryptococcal Infection of the Larynx in a Patient with Severe Chronic Obstructive Pulmonary Disease: A Case Report

Conclusion Methods Cryptococcus neoformans is an opportunistic, encapsulated yeast that can cause both primary pulmonary infections or disseminated infections of the skin, brain, and bone mainly in immunocompromised patients such as those with the acquired immunodeficiency syndrome (AIDS). There have only been seven cases of cryptococcal laryngitis that have been reported previously in the literature1-7. The majority of reported cases were in immunocompromised patients; however, there have been reported cases in immunocompetent hosts. Relative to other fungal infections of the larynx, C. Neoformans laryngitis is rare. Common symptoms include a history of prolonged hoarseness and chronic cough. Gross features as seen by indirect laryngoscopy demonstrate laryngeal edema and erythema and multiple white, raised lesions involving the true vocal folds. One report describes a single submucosal cystic lesion involving only the right vocal fold.7 All reported cases were limited to the glottic larynx without supra or subglottic extension. Treatment regimens for cryptococcal laryngitis have varied. While some cases required no treatment, others were placed on antifungals such as fluconazole and even amphotericin. None of the previous patients were treated for more than eight weeks, and all had resolution of their symptoms. We present a case of cryptococcal laryngitis in which the host was not only systemically immunocompromised, but also locally because of her chronic use of inhaled steroids. In addition, we report a case with an extended treatment course and introduce a novel treatment strategy for this disease.