Law Richard H, Reyes Samuel A
Department of Otolaryngology, University at Buffalo School of Medicine and Biomedical Sciences (SUNY), 1237 Delaware Avenue, Buffalo, NY 14209, USA.
Case Rep Otolaryngol. 2016;2016:1234196. doi: 10.1155/2016/1234196. Epub 2016 Feb 3.
Laryngeal aspergillosis is most commonly seen as a result of secondary invasion from the lungs and tracheobronchial tree in immunocompromised hosts. Primary aspergillosis of the larynx is, however, rare with few cases documented over the past fifty years. We report a case of a 73-year-old woman who presented with persistent hoarseness. She is a nonsmoker with a history of asthma and chronic bronchiectasis treated with bronchodilators, inhaled and oral corticosteroids, and nebulized tobramycin. Direct laryngoscopy with vocal cord stripping confirmed the diagnosis of invasive aspergillosis with no manifestations elsewhere. The patient was successfully treated with oral voriconazole with no signs of recurrence. Although several major risk factors contributing to the development of primary aspergillosis of the larynx have been discussed in the literature, there has been no mention of inhaled antibiotics causing this rare presentation to the best of our knowledge. We, therefore, highlight the use of inhaled tobramycin as a unique catalyst leading to the rapid onset of this rare presentation.
喉曲霉菌病最常见于免疫功能低下宿主因肺部及气管支气管树继发感染所致。然而，原发性喉曲霉菌病罕见，在过去五十年中仅有少数病例报道。我们报告一例73岁女性，表现为持续性声音嘶哑。她不吸烟，有哮喘和慢性支气管扩张病史，接受支气管扩张剂、吸入和口服皮质类固醇以及雾化妥布霉素治疗。直接喉镜检查及声带剥脱术确诊为侵袭性曲霉菌病，无其他部位表现。患者口服伏立康唑治疗成功，无复发迹象。尽管文献中已讨论了导致原发性喉曲霉菌病发生的几个主要危险因素，但据我们所知，尚未提及吸入性抗生素导致这种罕见表现。因此，我们强调吸入性妥布霉素作为导致这种罕见表现迅速出现的独特催化剂的作用。
