Original ArticleMalignant Mimickers: Chronic Bacterial and Fungal Infections of the Larynx
Introduction
Chronic granulomatous infections of the larynx comprise a large list of systemic conditions that, once disseminated, can affect the larynx in such a way that it can resemble the picture of squamous cell carcinoma. Historically, these “mimickers” were treated aggressively, which led to extensive resections of what proved to be benign disease. In recent years, an increased awareness of these illnesses has prompted a move toward a more thorough evaluation for what might have traditionally been categorized as cancer based on the presenting symptoms of dyspnea, hoarseness, odynophagia, weight loss, and/or a history of tobacco and alcohol abuse. The importance of sending cultures at the time of biopsy becomes evident when including these diseases in the differential diagnosis of laryngeal lesions. The clinical mimicry of chronic laryngeal infections will be illustrated in two case reports, followed by a discussion of the various bacterial and fungal pathogens.
Section snippets
Case 1
Patient 1 was 37 years old when he came to our clinic with a 6-month history of fluctuating hoarseness, which had become more constant over the previous few months. He had associated vague throat pain of increasing intensity. Despite no difficulties eating, he reported a 100-pound weight loss over the past year. In the 2 to 3 weeks before his office visit, he suffered from shortness of breath when lying supine. His medical and surgical histories were unremarkable. He admitted to smoking one
Case 2
Patient 2 was a 29-year-old man with a 2-year history of hoarseness that began several weeks after sustaining a direct blow to the neck during a fight. He denied any dysphagia, odynophagia, or respiratory distress. His medical history was unremarkable. He reported no tobacco use and occasional alcohol intake. He was born in Mexico and moved to the United States a year before presentation. He reported a remote history of farming with exposure to cattle and horses.
The patient was a mildly obese
Discussion
Chronic granulomatous lesions of the larynx are caused by many pathogens, which can be subcategorized as bacterial, fungal, parasitic, and idiopathic. In this article, the focus will be on the former two elements. Bacterial and fungal infections, aside from exhibiting noteworthy symptoms and morbidity, are elusive and misleading, and they can guide the clinician down the incorrect treatment algorhythm. A thorough evaluation, including direct laryngoscopy, biopsy, and culturing of the lesion is
Conclusions
In general, chronic bacterial and fungal infections of the larynx have similar histories and clinical signs and symptoms. The distinction between the various fungal and bacterial infections becomes important once laryngeal carcinoma is ruled out of the differential. However, for the clinician to reach that step, a cognizance of these elusive conditions is necessary so that the appropriate cultures and tests are performed. Specifically, we recommend obtaining a routine gram stain, aerobic and
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Presented at the Voice Foundation Annual Meeting, June 2002.