Mucosal Bridge and Pitting of the True Vocal Fold: An Unusual Complication of Cidofovir Injection

Abstract

We describe a unique complication of intralaryngeal cidofovir injection and present the case of a patient with recurrent respiratory papillomatosis in whom both a mucosal bridge and a pit of the true vocal fold developed after intralaryngeal cidofovir injection. A 40-year-old man presented with laryngeal papillomatosis 19 years after being treated with surgery and adjuvant radiotherapy for leiomyosarcoma of the cervical esophagus. The patient underwent 5 papillomatosis excisions combined with subepithelial injections of cidofovir to the bilateral true vocal folds at a concentration of 5 mg/mL without any complications. He subsequently received 2 higher-dose cidofovir treatments 6 weeks apart because of a poor response to the previous treatments. Two months later, there was evidence of a large mucosal bridge along the free edge of the right vocal fold and a deep pit in the lateral aspect of the same vocal fold. We conclude that repeated high-dose intralesional injection of cidofovir may result in significant morphological changes to the vocal fold, most likely due to mucosal injury.