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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 this article. 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. Case report 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. E: 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 97