Table 1.
Summary of cases of laryngeal cryptococcosis.
| Reference | Age | Risk factors | Cryptococcus antigen | Gross lesion | Histopathology | Treatment and outcome |
|---|---|---|---|---|---|---|
| Reese and Coclasure (5) | 47 M | Chicken manure | Positive | Marked laryngeal edema, glottis obstruction, multiple white raised exudative lesions | Pseudoepitheliomatous hyperplasia, granulomatous, budding yeast cells with large capsules, alcian blue+ | Urgent tracheostomy, IV amphotericin for 1/12 (2 g) |
| Pathological resolution 6/12 later | ||||||
| Smallman et al. (1989) (31) | 31 F | Nil | Negative | Warty 0.5 lesion inferior to right true cord | Pseudoepitheliomatous hyperplasia, foreign body giant cells, mucicarmine and alcian blue+ | Excisional biopsy. Patient refused further Rx |
| Symptomatic resolution 1/12 post. Recurrence below right cord | ||||||
| Browning et al. (1992) (8) | 46 M | HIV | Unknown | Right true cord erythema and edema from vocal process to anterior commissure | Granulomatous inflammation, methanamine silver and PAS+ | Amphotericin B (120 mg for 4/7) then fluconazole |
| Cryptococcal pneumonia | Symptomatic and pathological resolution | |||||
| Frisch and Gnepp (1995) (12) | 73 M | T2DM | Negative | Hyperemic fusiform mass on anterior 2/3 left false cord | Dense fibrous and granulation tissue, microcystic spaces with yeast structures, methanamine silver and mucicarmine+ | Excisional biopsy |
| Symptomatic resolution and no recurrence at 5/12 | ||||||
| Kerschner et al. (1995) (14) | 61 M | Oral prednisolone | Positive | Posterior commissure lesion, exophytic mass extending to arytenoids and false cords | Granulomatous, budding yeasts. mucicarmine+ | Single dose 400 mg oral fluconazole, then 200 mg daily for 6/52Pathological and symptomatic resolution |
| T2DM | ||||||
| Ex-smoker (35 pack-year history) | ||||||
| Isaacson and Frable (1996) (18) | 87 M | High-dose inhaled corticosteroid | Negative | Right anterior true vocal cord lesion—white and exudative | Pseudoepitheliomatous hyperplasia, marked submucosal inflammation. Methenamine silver and mucicarmine+ | Fluconazole 400 mg/day for 2/12 |
| COPD, smoker | Cessation of inhaled steroids | |||||
| Chongkolwatana et al. (1998) (10) | 42 M | HIV+ | Negative | Redness and irregularity of right anterior vocal cord and entire left vocal cord. Cords mobile, decreased amplitude and absence of mucosal wave on left cord | Pseudoepitheliomatous hyperplasia. Mucicarmine+ | Fluconazole 400 mg/day for 8/52. Pathological resolution 9/12 from treatment. Symptomatic resolution |
| Previous pulmonary TB | ||||||
| McGregor et al. (13) | 60 M | T2DM | Unknown | Right anterior true cord—verrucous lesion | Granulomatous inflammation, giant cell formation. Pseudoepitheliomatous hyperplasia, methanamine silver and mucicarmine+ | Fluconazole 6/52 |
| Ex-smoker | Decreased right cord mobility | Symptomatic resolution. No evidence of pathological recurrence | ||||
| Tobacco chewer | ||||||
| Nadrous et al. (2004) (16) | 55 M | Inhaled corticosteroid | Negative | Right true cord—anterior leukoplakia and whole cord erythema | Squamous hyperplasia | Itraconazole 200 mg BD for 6/52, followed by Fluconazole 400 mg/daily for 10/52 |
| Intermittent systemic steroids for asthma | Acute and chronic histiocytic inflammation | Symptomatic and pathological resolution | ||||
| Bamba et al. (2005) (21) | 68 F | Smoking (50 pack-year history) | Unknown | Smooth sphenoid cystic mass in superomedial surface of right vocal cord. Normal vocal cord mobility bilaterally | 2.5 subepithelial cystic specimen, containing small round monomorphic fungal bodies; alcian blue+, methenamine silver+ | Surgical excision |
| Symptomatic resolution post excision | ||||||
| Zeglaoui et al. (2005) (11) | 65 F | HIV+ | Positive | Infected budding lesion of laryngeal vestibule | Yeasts surrounded by capsules, consistent with Cryptococcus neoformans. Methenamine silver+ | Amphotericin B (0.7 mg/kg/day) for 3/52 then Fluconazole 400 mg/day for 6 months |
| Tumor-like with mobile cords | Pathological resolution. Death 11 months from diagnosis of AIDS from meningoencephalitis | |||||
| Joo et al. (2009) (17) | 82 F | Inhaled steroid | Positive | Edematous masses (right > left). Swelling and ulcerative-type masses on bilateral false vocal folds. Granulomas seen on posterior true vocal folds | Giemsa (GMS) and alcian blue stain+ | Itraconazole for 6/52, Fluconazole for 10/52, further 2/12 of oral fluconazole. 585 nm pulsed dye laser |
| Systemic corticosteroid for COPD | Incomplete pathological resolution at 4 months, 2× biopsy-confirmed residual laryngeal lesions. Near complete pathological resolution at 7 months with some symptomatic improvement | |||||
| Gordon et al. (2010) (9) | 64 M | Inhaled corticosteroid | Unknown | Patches of leukoplakia around the vocal cords with irregular subglottic mucosal margins | Pseudoepitheliomatous hyperplasia. Granulomatous inflammation. Methenamine silver and mucicarmine+ | Fluconazole 400 mg/daily for 10/12 |
| Pathological resolution | ||||||
| Gordon et al. (2010) (9) | 44 M | HIV+ | Unknown | Bilateral thick, hyperemic vocal cords with subtle right cord irregularity. Thick anterior right vocal cord | Granulomatous inflammation, positive staining | Oral fluconazole for 3/12 |
| Hep C+ | Symptomatic resolution | |||||
| Smoker | ||||||
| Gordon et al. (2010) (9) | 79 F | Inhaled corticosteroids | Negative | Bilateral vocal cord thickening | Crytpcoccus, mild inflammatory response, bilateral vocal cord thickening | Daily Fluconazole for 6/12 |
| Complete resolution | ||||||
| Chang et al. (6) | 53 M | Exposure to pigeons | Negative | Mass on right posterior vocal cord | Squamous hyperplasia with acute and chronic inflammation, methenamine silver+, mucicarmine+ | Fluconazole 400 mg daily for 6/52 |
| Symptomatic and pathological resolution | ||||||
| Mittal et al. (2013) (19) | 58 M | Inhaled corticosteroid history of camping under eucalyptus trees one year prior | Negative | Congested red vocal cords. Irregular red lesion | Vocal fold squamous mucosa inflammation, thinned, and partially ulcerated. Alcian blue, methenamine silver+ | Fluconazole 500 mg daily for 8/52 |
| Bergeron et al. (2015) (20) | 78 F | Inhaled corticosteroid | Negative | Bilateral whitish vocal cords | Hyperplasia, inflammation. Leukoerythroplakia of right vocal cord. alcian blue, mucicarmine+ | Fluconazole 100 mg/daily for 4/52, fluconazole 100 mg/daily for 3/52, fluconazole 400 mg/daily for 15/52. Inhaled corticosteroids decreased. Symptomatic and pathological resolution |
| Jeng et al. (7) | 71 F | Inhaled corticosteroids | Unknown | Exophytic lesions on posterior cord and right false vocal cord. White exophytic lesion on right vestibular fold, bilateral arytenoids and bilateral true vocal folds | Necrotic debris, inflamed squamous mucosa and fungal lesions on right medial arytenoid | Fluconazole 100 mg/daily for 2/52, fluconazole for 6/12. Surgical debulking |
| Exposure to bird droppings | Symptomatic resolution at 4/12, pathological resolution at 11 months | |||||
| Tamagawa et al. (2015) (15) | 82 F | Systemic corticosteroid Salazosulfapyridine 500 mg daily | Positive | White exudative irregular lesion on right arytenoid | Pseudoepitheliomatous hyperplasia, severe submucosal inflammation. Methenamine silver+ | Excision biopsy. Fluconazole 200 mg/daily for 182 days. Reduced dosage of corticosteroid over 4/12. Pathological resolution |
| Current case 1 | 66 F | High-dose inhaled corticosteroids | Negative | Erythematous right true cord | Cryptococcoma with inflammatory infiltrate | Reduction of inhaled fluticasone to 1,000 µg/day. Fluconazole 200 mg BD for 6/12 |
| Intra-nasal steroid | Symptomatic and pathological resolution | |||||
| Current case 2 | 69 F | High-dose inhaled corticosteroids | Positive | Erythematous and thickened right true vocal cord | Cryptococcoma and infilammatory infiltrate, methenamine silver+ | Reduction of inhaled fluticasone to 1,000 µg/daily |
| Intermittent systemic steroid | Fluconazole 200 mg BD for 8/12 | |||||
| Symptomatic and pathological resolution | ||||||