Laryngeal aspergillosis following high dose inhaled fluticasone therapy for asthma.
The case history is presented of a 75 year old man with chronic asthma who was treated with inhaled fluticasone propionate in a daily dose of 2 mg using a Diskhaler. After three years of treatment he developed progressive hoarseness. Both vocal cords were colonised by Aspergillus fumigatus which formed a white slough on the surface. Biopsy specimens showed changes suggestive of laryngeal aspergillosis with an ulcerated epithelium, fibrinopurulent debris, and colonies of fungal hyphae. A slow recovery occurred after three months of treatment with topical amphotericin and with cessation of inhaled corticosteroids. Laryngoscopy is recommended if hoarseness occurs during treatment with fluticasone.
Fairfax
A J
AJ
Departments of Respiratory Medicine, Ear, Nose & Throat Surgery and Pathology, Staffordshire General Hospital, Weston Road, Stafford ST16 3SA, UK.
David
V
V
Douce
G
G
D000287:Administration, Topical; D000368:Aged; D000730:Androstadienes / Q000008:administration & dosage / Q000009:adverse effects*; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage / Q000009:adverse effects*; D001228:Aspergillosis / Q000139:chemically induced* / Q000188:drug therapy; D001232:Aspergillus fumigatus; D001249:Asthma / Q000188:drug therapy*; D000068298:Fluticasone; D005938:Glucocorticoids; D006801:Humans; D007818:Laryngeal Diseases / Q000139:chemically induced* / Q000188:drug therapy; D008297:Male
D000730:Androstadienes; D000893:Anti-Inflammatory Agents; D005938:Glucocorticoids; D000068298:Fluticasone