Laryngeal sporotrichosis causing stridor in a young child.
Fungal infections of the larynx are rare entities that must be considered in the differential diagnosis of the patient who presents with laryngeal symptoms. We present an unusual case of initially recurrent and then persistent stridor in a 19-month-old girl, unresponsive to 4 months of antibiotic and steroid therapy. Upon our laryngoscopic examination, the patient was noted to have an ulcerated, granulomatous process involving the larynx. She also had an erythematous papule on the left thigh. Fungal cultures of both sites grew Sporothrix schenckii. The patient was treated with systemic antifungal medications and had complete resolution of her symptoms. We discuss the pathophysiology and possible source of this unusual form of sporotrichosis, the first such case reported in a child. We emphasize the role of empiric steroid therapy in exacerbating and eventually enabling dissemination of the infection. We also review the manifestations of sporotrichosis infections of the head and neck. This case demonstrates the vital importance of careful diagnosis and proper treatment of stridor in children.
Khabie
Nissim
N
Department of Otorhinolaryngology, Division of Pediatric Otolaryngology, Mayo Clinic, Mayo Eugenio Litta Children's Hospital, 200 First St. SW, Rochester, MN 55905, USA.
Boyce
Thomas G
TG
Roberts
Glenn D
GD
Thompson
Dana M
DM
D000893:Anti-Inflammatory Agents / Q000009:adverse effects; D000935:Antifungal Agents / Q000627:therapeutic use; D005260:Female; D006099:Granuloma / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D006685:Hoarseness / Q000188:drug therapy / Q000382:microbiology; D006801:Humans; D007223:Infant; D007827:Laryngitis / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology*; D007828:Laryngoscopy; D011239:Prednisolone / Q000009:adverse effects; D012008:Recurrence; D012135:Respiratory Sounds / Q000209:etiology*; D012878:Skin Neoplasms / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology; D013175:Sporothrix / Q000302:isolation & purification*; D013174:Sporotrichosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D014136:Tracheitis / Q000382:microbiology
D000893:Anti-Inflammatory Agents; D000935:Antifungal Agents; D011239:Prednisolone