Cryptococcus Neoformans

Cryptococcus of the larynx is a fungal infection of the larynx caused most commonly by Cryptococcus neoformans and sometimes Cryptococcus gattii. Compared with more common histoplasmosis and even blastomycosis, this is a truly rare disease that is estimated to affect fewer than 1 per 100,000 people in Illinois.

Usually, this fungal disease involves the lung or central nervous system in severely immunocompromised individuals, but it can present as an uncommon localized form of cryptococcal infection affecting the larynx.

It is most often seen in immunocompromised people such as those with HIV/AIDS, transplant patients, etc. It can be seen, however, in immunocompetent people, especially (but still rarely) in those using inhaled corticosteroids on a chronic basis. Though a source of the organisms can be the dust from the droppings of birds, especially pigeons, the disease is even rare in pigeon keepers.

Symptoms

The presentation is most commonly with persistent hoarseness or a nagging sore throat.

Careful laryngeal examination shows a bumpy, granular appearance, such as seen in the example below. It can mimic laryngeal cancer at first appearance, but biopsy specimens stained with India Ink or mucicarmine instead shows encapsulated yeast and inflammatory/granulation tissue. If organisms are occult, “granulation” is the usual description. Culture of the organism can be attempted, but takes some weeks to get results.

Treatment

Treatment is with antifungal medication such as fluconazole, itraconazole, etc. Severe cases may require amphotericin B. Prognosis is generally good, assuming the patient is not severely immunocompromised.