title: Primary aspergillosis of vocal cord: Long-term inhalational steroid use can be the miscreant.
abstract: Primary laryngeal aspergillosis is extremely rare, especially in an immunocompetent host. It is commonly found as a part of systemic infection in immunocompromised patients. A case of vocal cord aspergillosis with no systemic extension in an immunocompetent patient on long-term steroid metered dose inhaler (MDI) is presented here, because of its rarity. The present case is a 28-year-old asthmatic female who was on inhalational steroid for 8 years, presented with sudden onset of severe dysphonia for 5 days. Fiberoptic laryngoscopy demonstrated whitish plaque involving right vocal cord, clinically suggestive of fungal laryngitis. Microlaryngeal laser surgery was performed with stripping of the plaque. Histopathology demonstrated ulcerated hyperplastic squamous epithelium with masses of fungal hyphae, which was confirmed to be Aspergillus species on fungal culture. This rare but serious adverse effect of long-term steroid MDI use must be kept in mind while treating an asthmatic patient. We also present a brief review of literature of laryngeal aspergillosis.
authors.affiliation: Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India. Electronic address: dr_arpita001@yahoo.co.in.
authors.forename: Arpita
authors.initials: A
authors.lastname: Saha
authors.affiliation: Department of Pathology and Laboratory Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
authors.forename: Kaushik
authors.initials: K
authors.lastname: Saha
authors.affiliation: Department of Pathology, IPGMER, Kolkata, West Bengal, India.
authors.forename: Uttara
authors.initials: U
authors.lastname: Chatterjee
mesh_terms: D000280:Administration, Inhalation; D000328:Adult; D001228:Aspergillosis / Q000139:chemically induced*; D001249:Asthma / Q000188:drug therapy*; D005260:Female; D000068298:Fluticasone / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D007818:Laryngeal Diseases / Q000139:chemically induced*; D014827:Vocal Cords
chemical_list: D000068298:Fluticasone
keywords: Fiberoptic laryngoscopy; Laryngeal aspergillosis; Microlaryngeal laser surgery; Steroid metered dose inhaler; Vocal cord