title: Methicillin-resistant Staphylococcus aureus laryngitis: a report of two cases with different clinical presentations.
abstract: BACKGROUND
  Methicillin-resistant Staphylococcus aureus (MRSA) infection has been described in multiple areas of the head and neck. Recently, otolaryngologists have recognized MRSA infection in the glottis. We describe 2 cases of MRSA laryngitis with divergent clinical presentations: acute airway obstruction and recalcitrant hoarseness.
  
  
  METHODS
  Report of 2 cases and review of the literature.
  
  
  RESULTS
  In the first case, a 44-year-old woman presented with near aphonia despite maximal medical therapy. Examination showed diffuse erythema and edema of the endolarynx with yellowish plaques lining the glottis and supraglottis. Complete resolution was achieved with long-term trimethoprim-sulfamethoxazole. In the second case, a 54-year-old woman presented with recent-onset hoarseness with rapid progression to respiratory distress and biphasic stridor. Endoscopy revealed exuberant granulation tissue in the glottis with a narrowed airway. Treatment required prolonged courses of antibiotics and steroids. Diagnosis in both cases was confirmed with biopsies taken during direct laryngoscopy.
  
  
  CONCLUSIONS
  MRSA treatment is a growing part of otolaryngologic practice and should be included in the differential diagnosis of hoarseness and stridor.
authors.affiliation: Department of Otorhinolaryngology, Head and Neck Surgery, University of Pennsylvania, Philadelphia, PA 19104, USA. marcelo.antunes@uphs.upenn.edu
authors.forename: Marcelo B
authors.initials: MB
authors.lastname: Antunes
authors.forename: Evan R
authors.initials: ER
authors.lastname: Ransom
authors.forename: Kevin P
authors.initials: KP
authors.lastname: Leahy
mesh_terms: D000328:Adult; D003937:Diagnosis, Differential; D005260:Female; D005931:Glottis / Q000382:microbiology* / Q000473:pathology; D006801:Humans; D007827:Laryngitis / Q000382:microbiology* / Q000473:pathology; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000473:pathology; D014827:Vocal Cords / Q000382:microbiology* / Q000473:pathology