Cryptococcal laryngitis

Cryptococcus, histoplasmosis, leishmaniasis

The squamous mucosa of the vocal cord is inflamed, with focal intraepithelial vesicles and a moderate infiltrate of acute and chronic inflammatory cells. Within the infiltrate there are numerous microorganisms which measure 3-6 microns in diameter and are surrounded by a clear halo. Some of the organisms demonstrate narrow-based budding. The included mucicarmine stain demonstrates the presence of mucin within the capsule of the organisms, confirming the diagnosis of cryptococcal laryngitis. As further confirmation, the fungal culture of the operative specimen grew Cryptococcus neoformans. Cryptococcus is an encapsulated yeast with two main species that cause disease in humans (C. gatii and C. neoformans). In North America, C. neoformans is the common species and is most often found in the environment in association with bird droppings. Cryptococcal infections are most often seen in immunocompromised patients, with the most common sites of infection being the central nervous system and lungs. However, Cryptococcus does sporadically infect patients with competent immune systems, though the degree of infection is less severe. The larynx is an unusual site for infection. When it does occur, it may mimic an early laryngeal carcinoma in its clinical findings and its gross appearance.

1. J Med Assoc Thai. 1998 Jun;81(6):462-7. Primary cryptococcal infection of the larynx in a patient with AIDS: a case report. Chongkolwatana C, Suwanagool P, Suwanagool S, Thongyai K, Chongvisal S, Metheetrirut C. 2. Arch Otolaryngol. 1975 Nov;101(11):698-701. Cryptococcosis of the larynx. Reese MC, Colclasure JB. 3. South Med J. 2003 Jan;96(1):74-7. Cryptococcal infection of the larynx simulating laryngeal carcinoma. McGregor DK, Citron D, Shahab I.