A Rare Cause of Hoarseness: Primary Laryngeal Aspergillosis in a Postpartum Patient

Abstract

Objectives:

1) Present a rare cause of hoarseness in a seemingly healthy, immunocompetent, postpartum patient. 2) Discuss the probable contributing factors leading to the unusual presentation of the disease process.

Methods:

Case report study conducted from January-December 2012. Subject: A 28 year old, immune competent female diagnosed with primary laryngeal aspergillosis.

Results:

Aspergillus is a saprophyte known to be weakly pathogenic and opportunistic in human beings. For centuries since its discovery, it has mostly been regarded as a disease of the immuno-compromised. When it does cause disease it most commonly affects only the lungs and tracheo-bronchial tree with subsequent systemic dissemination and involvement of other organs during its fulminant stage. Primary laryngeal aspergillosis is uncommon, and an even greater rarity is to have the disease manifest in a patient with an intact immune system. Here we present a case of a young female presenting with cough and hoarseness immediately postpartum which later was identified as a case of primary Aspergillosis of the larynx. Initially she was managed with antibiotics, PPIs, and corticosteroids, but this did not resolve her symptoms. Direct suspension micro-laryngoscopy with excision of TVF mass revealed tissue sections with characteristic appearance of Aspergillus sp.

Conclusion:

There has been an increasing number of reported cases of primary laryngeal aspergillosis in the immunocompetent. The possibility of a primary laryngeal aspergillosis should be one of the differential diagnoses when dealing with patients who respond poorly to conventional treatment. It should also not be quickly dismissed merely on the basis of the patient’s good immune status.