Candida of the larynx. (Laryngoscopic Clinic).

A 50-year-old woman with a medical history of hypertension and depression was admitted to the hospital for exacerbation of her chronic obstructive pulmonary disease. On admission, she was treated with nebulized albuterol, methylprednisolone sodium succinate injection, and levofloxacin. Her outpatient medications included aspirin, ranitidine, celecoxib, sertraline, and lansoprazole. She admitted to alcohol, tobacco, and cocaine use. During her hospitalization, she developed hoarseness and dysphagia, which prompted an otolaryngology consultation.

Significant findings on examination included the presence of white lesions on the soft palate, erythema and edema of the arytenoid cartilages, and white lesions on the vocal folds (figure). The differential diagnosis included Candida infection and dysplasia/carcinoma. Because of her smoking history, other medical factors, and concern about follow-up, a prompt biopsy was recommended. (In other clinical situations, biopsy may be delayed pending empiric [or culture-based] treatment with antifungal medications.) Panendoscopy with biopsy of the vocal folds was performed and the specimen was also sent for fungal cultures.

Histologic evaluation of the biopsy specimen confirmed the presence of fungal elements consistent with Candida infection. Oral fluconazole was administered for 2 weeks, and the patient's symptoms resolved. Antibiotic therapy, steroid therapy, diabetes, human immunodeficiency virus infection, radiation, chemotherapy, and any condition that suppresses immune response can predispose patients to laryngeal candidiasis.

From the Philadelphia College of Osteopathic Medicine (Dr. De Pasquale) and the Department of Otolaryngology--Head and Neck Surgery, Thomas Jefferson University (Dr. Sataloff), Philadelphia.