Author(s)
Taylor G. Lackey, MD
James R. Duffy, BS
Daniel S. Fink, MD
Affiliation(s)
Department of Otolaryngology and Head & Neck Surgery, University of Colorado, Aurora CO
Abstract:
Background/Objectives: We report a case of isolated laryngeal mucormycosis in a patient who presented in diabetic ketoacidosis (DKA). The patient was managed with antifungal therapy and eventual total laryngectomy. To our knowledge, this is the first case presented of mucormycosis with isolated laryngeal involvement.
Methods: Case report and review of the literature.
Results: A 66-year-old female was admitted in DKA and developed stridor on hospital day 3. Concern for infection of the larynx was demonstrated on flexible laryngoscopy, and persistent failure to improve on routine therapy led to biopsy and diagnosis of invasive mucormycosis. Despite antifungal therapy and surgical debridement, erosive changes of the thyroid and cricoid cartilage were evident on imaging. Laryngectomy was performed to definitively obtain source control and provide better quality of life in a non-functional larynx with fungal organisms noted in the specimen. The patient is alive and well 3 months following hospitalization.
Conclusion: Invasive laryngeal mucormycosis is an extremely rare and exceedingly morbid condition. Clinical threshold for direct laryngoscopy and biopsy should be low for patients with associated risk factors who develop stridor. Despite antifungal therapy, surgical resection including laryngectomy may be indicated to provide better quality of life and definitive treatment in this population.