Laryngeal and esophageal histoplasmosis.

A 54-year-old man came to us with complaints of hoarseness and globus that had stabilized over the course of several months. He was otherwise healthy and did not smoke or abuse alcohol.

Transnasal fiberoptic laryngoscopy revealed the presence of a verrucous lesion on the anterior third of the left true vocal fold (figure, A). Transnasal esophagoscopy (TNE) detected small white plaques throughout the entire length of the esophagus (figure, B). In addition, TNE also showed grade I esophagitis in the distal third of the esophagus and metaplastic gastric epithelium that extended 6 cm above the lower esophageal sphincter (figure, C).

Analysis of laryngeal and esophageal biopsy specimens revealed the presence of fungal elements consistent with a diagnosis of histoplasmosis (figure, D). The patient was referred to an infectious disease specialist for systemic treatment, and he is currently undergoing therapy with itraconazole. A repeat endoscopy with four-quadrant biopsies for surveillance of Barrett's metaplasia will be performed in 1 year.