title: Invasive fungal laryngopharyngitis resulting in laryngeal destruction with complete laryngotracheal separation: Report of a case.
abstract: As the treatment of hematopoietic cancers evolves, otolaryngologists will see a higher incidence of opportunistic infections. We discuss a case of invasive fungal disease that invaded the larynx, pharynx, trachea, and pulmonary parenchyma after chemotherapy. The patient, a 46-year-old woman, presented 1 week after undergoing induction chemotherapy. Her initial symptoms were odynophagia and dysphagia. Despite encouraging findings on physical examination, her health rapidly declined and she required an urgent tracheotomy and multiple operations to address spreading necrosis. Because of her inability to heal, she was not a candidate for laryngectomy, so she was treated with conservative management. The patient was then lost to follow-up, but she returned 5 months later with laryngeal destruction and a complete laryngotracheal separation. While noninvasive fungal laryngitis is routinely encountered, its invasive counterpart is rare. The literature demonstrates that some cases completely resolve with medical therapy alone but that surgery is necessary in others. We recommend surgical debridement of all necrotic tissue.
authors.affiliation: Midwestern University-Arizona College of Osteopathic Medicine, 19555 N. 59th Ave., Glendale, AZ 85308, USA. tylerswiss@gmail.com.
authors.forename: Tyler
authors.initials: T
authors.lastname: Swiss
authors.forename: Sergio Santino
authors.initials: SS
authors.lastname: Cervantes
authors.forename: Michael
authors.initials: M
authors.lastname: Hinni
authors.forename: David G
authors.initials: DG
authors.lastname: Lott
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000150:complications / Q000276:immunology / Q000628:therapy; D002177:Candidiasis / Q000150:complications / Q000276:immunology / Q000628:therapy; D060085:Coinfection / Q000150:complications / Q000276:immunology / Q000628:therapy; D003354:Corynebacterium Infections / Q000150:complications / Q000276:immunology / Q000628:therapy; D003646:Debridement; D003680:Deglutition Disorders / Q000209:etiology; D055154:Dysphonia / Q000209:etiology; D005260:Female; D016908:Gram-Positive Bacterial Infections / Q000150:complications* / Q000276:immunology / Q000628:therapy; D006801:Humans; D016867:Immunocompromised Host / Q000276:immunology*; D060828:Induction Chemotherapy / Q000009:adverse effects; D000072742:Invasive Fungal Infections / Q000150:complications* / Q000276:immunology / Q000628:therapy; D007827:Laryngitis / Q000150:complications* / Q000276:immunology / Q000628:therapy; D015470:Leukemia, Myeloid, Acute / Q000150:complications / Q000188:drug therapy; D008169:Lung Abscess / Q000150:complications* / Q000276:immunology / Q000628:therapy; D008875:Middle Aged; D009190:Myelodysplastic Syndromes / Q000150:complications / Q000188:drug therapy; D010612:Pharyngitis / Q000150:complications* / Q000276:immunology / Q000628:therapy; D014057:Tomography, X-Ray Computed; D014140:Tracheotomy
chemical_list: D000900:Anti-Bacterial Agents; D000935:Antifungal Agents