Candida laryngitis

Abstract

A 44-year-old woman with a medical history of diabetes mellitus was admitted to the hospital for dyspnea, dysphagia, and odynophagia, which had begun a month before. On examination, it was observed that she had severe stridor. There were rhonchi on auscultation of the chest. Oropharyngeal mucosa was observed to be hyperemic and edematous. There was a moderate amount of mucosal edema and erythema that involved the entire larynx. Adherent white-yellow plaques and shallow ulcerations were seen through laryngoscopic examination. The culture of the swap sample confirmed the presence of Candida albicans. Therefore, topical nystatine and oral fluconazole were chosen for medical therapy. After the start of medication, dyspnea was resolved in 1 week. After 4 weeks, results of an endoscopy of the larynx indicated a normal condition. Candida infection occurs especially when the host immune mechanisms and protective mucosal barrier are both impaired.1 The outcome of laryngeal candidiasis depends on the underlying condition of the patient. Early diagnosis and medical therapy is important for several reasons. First, upper airway obstruction can lead to mortality, especially among young infants. Laryngeal scarring with permanent voice impairment can be observed at chronic inflammation. And morbidity may be significant in a widely disseminated form of the disease. Upper airway obstruction that causes stridor has a wide differential diagnosis. To make the diagnosis, clinical suspicion is necessary because fungal laryngitis is an infrequent condition in the cause of upper airway obstruction. Common symptoms of laryngeal candidiasis include dyspnea, dysphagia, and hoarseness. Laryngoscopy may reveal an inflamed, friable mucosa with white-yellow exudates or irregularly thickened, dense, white tissue that covers the vocal cord. However, all these findings may also simulate carcinoma. For a definitive diagnosis, the physician should make laryngeal cultures and cytology of the specimen, obtained by brushing. In cases of incomplete response to medical therapy or suspicion of malignancy, biopsy should be considered. Antifungal agents are used for medical therapy for 3 or 4 weeks.2 Delay in diagnosis can result in, at best, laryngeal scarring with permanent voice impairment and, at worst, demise from unrelieved airway obstruction.3 To conclude, the successful management of laryngeal candidiasis relies on clinical suspicion, examination, prompt diagnosis, and appropriate medical therapy (Fig 1). Laryngoscopic view with mucosal edema, erythema, adherent white-yellow plaques, and shallow ulcerations.