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Case Report Laryngeal Cancer
Invasive Epiglottic Aspergillosis Mimicking
Supraglottic Laryngeal Carcinoma—A Case
Report and Review of the Literature
Michel Kmeid, 1 Elie Azar, 1 Selim Nasser, 2 Pierre Abi Hanna, 1 Maya Saroufim, 2 and Nabil Moukarzel 1
1. Lebanese University, Beirut, Lebanon; 2. Lebanese American University, Byblos, Lebanon
B ackground: Invasive laryngeal aspergillosis is an uncommon disorder. The presentation can be misleading, mimicking other laryngeal
disorders, specifically laryngeal cancer. The isolated involvement of the larynx is even more unusual making the diagnosis even more
challenging. Case report: We describe the case of a 66-year-old man with diabetes who presented with a sore throat, low grade fever,
dysphagia, and odynophagia of 3 days duration. He was initially diagnosed as having a supraglottic laryngeal cancer with involvement and
paralysis of the left vocal cord. However, further histopathologic examination revealed the presence of an invasive epiglottic aspergillosis with no
evidence of malignancy. He was treated with surgical debridement and voriconazole for 3 weeks and responded well to therapy with full recovery.
Conclusion: In the presence of laryngeal ulcerative and/or granulomatous lesions, the possibility of invasive fungal laryngitis (aspergillosis
specifically), although improbable, should always be kept in mind especially in the presence of predisposing conditions. Starting empiric antifungal
therapy is integral when the disease is suspected but therapy is often delayed until pathologic confirmation is obtained. Prognosis is usually poor
and will depend on the immune status of the patient.
Keywords Supraglottic laryngeal cancer, fungal laryngitis,
invasive laryngeal aspergillosis
Disclosure: Michel Kmeid, Elie Azar, Selim Nasser, Pierre
Abi Hanna, Maya Saroufim, and Nabil Moukarzel certify
that they have no afﬁliations with or involvement in any
organization or entity with any ﬁnancial or non-ﬁnancial
interest in the subject matter or materials discussed in this
manuscript. No funding was received in the publication of
Authorship: All named authors meet the International
Committee of Medical Journal Editors (ICMJE) criteria
for authorship of this manuscript, take responsibility for
the integrity of the work as a whole, and have given final
approval to the version to be published.
Compliance with Ethics Guidelines: All procedures
were followed in accordance with the responsible
committee on human experimentation and with the
Helsinki Declaration of 1975 and subsequent revisions, and
informed consent was received from the patient involved
in this case study.
Open Access: This article is published under the Creative
Commons Attribution Noncommercial License, which
permits any noncommercial use, distribution, adaptation,
and reproduction provided the original author(s) and
source are given appropriate credit.
Fungal laryngitis is an uncommon condition. The exact incidence is not well defined as very few
cases have been reported in the literature. Candida is the most common pathogen involved, with
Aspergillus species coming in second. 1–3 Other rare causes of fungal laryngitis such as cryptococcosis,
blastomycosis, and histoplasmosis have also been reported. 4,5 This case report will focus on laryngeal
aspergillosis, which can be classified into chronic non-invasive, allergic, and invasive forms. 6 The
disease process relies on two aspects: firstly, the direct clinical and pathological resemblance to other
disorders of the larynx, specifically laryngeal carcinoma and premalignant lesions, which can often
make the diagnosis challenging with a considerable impact on management. Secondly, identifying
at risk patients is fundamental even in the absence of gross immunosuppression as this allows for
earlier diagnosis and treatment, which is crucial for the invasive forms. We describe herein the case
of a 66-year-old man, initially suspected to have a supraglottic laryngeal carcinoma with vocal cord
paralysis that was finally diagnosed with an invasive epiglottic aspergillosis with cartilage destruction
and abscess formation.
A 66-year-old man presented to the emergency department with a sore throat and low grade
fever of three days duration associated with dysphagia and odynophagia. The patient was a heavy
smoker and moderately consumed alcohol. He complained of progressive dysphonia over several
months, which he attributed to his smoking history. He suffered from diabetes mellitus managed
with oral metformin therapy.
Received: July 28, 2016
Accepted: October 28, 2016
Citation: Oncology & Hematology Review,
2016;12(2):97–100 Corresponding Author: Michel Kmeid, School
of Medicine, Lebanese University, Beirut, Lebanon.
TOU CH MED ICA L MEDIA
Head and neck examination did not reveal any trismus or significant pathology of the oral cavity
and oropharynx. No palpable neck masses or pathologic lymph nodes were identified. Therefore, a
nasal fibroscopic exam was done and revealed the presence of a midline epiglottic ulcer extending
to the left aryepiglottic fold and piriform sinus with consequent paralysis of the left vocal cord. The
patient was suspected to have an ulcerative supraglottic laryngeal carcinoma with suppuration
and possible abscess formation, and was admitted and administered intravenous (IV) clindamycin
and dexamethasone. A chest X-ray was performed and was unremarkable. A neck computed
tomography (CT) scan with IV contrast and neck magnetic resonance imaging (MRI) were carried
out and suggestive of a tumoral process with necrosis and suppuration (see Figures 1 and 2).
A few days later and after clinical improvement, microlaryngeal surgery for debridement and