Abstract
Objectives: The goal of this presentation is to discuss a unique presentation of a T-lymphocyte disorder involving airway obstructing laryngeal candidiasis.
Methods: Case report.
Results: A 62-year-old African-American male was initially evaluated in April 2001 for hoarseness, dyspnea, and a 40-lb weight loss. His medical history included hypertension, gastroesophageal reflux, and prostate cancer, which was treated surgically 6 years previously. Direct laryngoscopy showed an exophytic ball-valving lesion based posteriorly in the interarytenoid region. Excisional biopsy results showed fungal elements consistent with the candidal organism. The patient was treated with oral fluconazole 400 mg daily for 10 days with resolution of his symptoms. Ten months after his initial evaluation, the patient complained of gradually worsening dyspnea and was noted to have biphasic stridor and preferred the classic epiglottic position. Videostroboscopy showed a 2- to 3-mm diameter glottis obstructed by an interarytenoid ball-valving mass with a gray-white plaque that extended anteriorly along the false vocal folds. An urgent tracheotomy under local anesthesia was accomplished. Further testing was negative for immunoglobulin deficiencies, human immunodeficiency virus, and serum angiotensin converting enzyme. After a third recurrence of laryngeal candidiasis, he was referred for infectious disease consultation that included an immune deficiency work-up. The patient had a t-lymphocyte disorder indicated by a nonreactive anergy panel (including nonreactivity to candida) with intact humoral immunity.
Conclusion: To the best of our knowledge, this is the first case of a T-cell disorder presenting in an adult with airway compromise caused by invasive laryngeal candidiasis.