PRIMARY LARYNGEAL CRYPTOCOCCOSIS ASSOCIATED WITH PROLONGED INHALED STEROID USE. A CASE REPORT AND LITERATURE REVIEW

Abstract

Primary Laryngeal Cryptococcosis is a rare clinical entity. Prolonged use of inhaled corticosteroids has been reported in previous literature as a significant risk factor in the pathogenesis of the disease. We report here a case of biopsy proven isolated laryngeal cryptococcosis without pulmonary ` in an elderly male. Our patient had a history of Asthma with prolonged use of inhaled corticosteroids for >15 years. Serum Cryptococcal Antigen titers were also raised. Managed medically with oral Fluconazole with reduction in dose of inhaled steroids, for 6 months duration with complete resolution of symptoms and improvement in titers. We also present a review of literature of cases reported in the last 22 years. A total of 25 cases have been reported and all of them presented with hoarseness of voice, had varied macroscopic and histopathological appearances, often mimicking malignancy. Sensitivity of serum Cryptococcal antigen remained low (39%). Majority (>60%) patient had long term exposure to high-dose inhaled steroids for varied duration. Anti-fungal therapy (Fluconazole) was instituted in most cases with good outcomes and only few cases required surgical excision or laser therapy for residual lesions. Reduction in dose of inhaled steroids for risk factor modification along with anti- fungal therapy can be effective in treatment of Cryptococcal Laryngitis.

Keywords: Cryptococcus neoformans, Laryngeal Cryptococcosis, Inhaled corticosteroids