Primary Invasive Aspergillosis of the Larynx in an Immunocompromised Patient: A Case Report

The authors discuss here the case of a 66-year-old man, recently diagnosed with aplastic anemia leading to pancytopenia, who developed a sore throat and dysphonia. Indirect laryngoscopy revealed a supraglottic edema. A cervical CT scan demonstrated right laryngeal mucosal oedema, extending over 6 cm. Diagnosis of primary laryngeal invasive aspergillosis was made based on biopsies performed 10 days after initial symptoms; a secondary pulmonary involvement was discovered on a renewed CT scan. Sequential treatment with amphotericin B followed by voriconazole and then isavuconazole was carried out. The authors performed a second suspension laryngoscopy and discovered extensive pharyngo–laryngo– tracheal necrosis. The authors opted for treatment de-escalation. Autopsy revealed invasive aspergillosis, involving the lungs, heart, liver, thyroid, larynx, and trachea. Laryngeal aspergillosis is rare, mostly arising as an extension of a pulmonary or systemic infection. The authors found only 10 other reported cases of primary laryngeal invasive aspergillosis in an immunocompromised patient; however, this case is the only 1 that became systemic. Laryngeal aspergillosis should be considered in the differential diagnosis of immunocompromised patients presenting with laryngitislike symptoms. Prophylactic treatment should be initiated promptly upon suspicion. Clinical diagnosis is challenging, and early biopsies will help to identify the fungus rapidly. Any delay in treatment may lead to fatal consequences.