Mycobacterium abscessus infection located on the larynx can be seen with vascular stippling under narrow band light and at closer range.

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scarring or extra tissue (1 of 6)

This immunocompromised patient is receiving monthly immunoglobulin infusions and has experienced many months of severe hoarseness. From a distance, one sees what looks like scarring or extra tissue mostly posteriorly.

Vascular stippling (2 of 6)

Under narrow band light and at closer range, notice the vascular stippling. The initial impression was that this might be a fungal infection such as blastomycosis.

Enlarged Abnormalities (3 of 6)

A month later, due to delay while optimizing her medical condition for brief general anesthesia, the abnormalities seem to have progressed/enlarged. Voice is even worse, and now the patient has mild symptoms of airway restriction.

Recovery after surgery (4 of 6)

A week after surgical debulking. Both voice and breathing are much improved.

Inflammatory polyp (5 of 6)

Six weeks later, airway remains excellent; voice has re-deteriorated due to this inflammatory “polyp.”

Thulium laser (6 of 6)

Office based thulium laser coagulation in progress…