Vocal fold cryptococcal granuloma: A rare occurrence in immunocompetent patient

Muhamamad Raziin Zainal Abidin; Syarifah Nafisah Syed Hamzah Al-Yahya; Masaany Mansor; Norazila Abdul Rahim

doi:10.1016/j.ijscr.2024.109228

Vocal fold cryptococcal granuloma: A rare occurrence in immunocompetent patient

Int J Surg Case Rep. 2024 Feb:115:109228. doi: 10.1016/j.ijscr.2024.109228. Epub 2024 Jan 9.

Authors

Muhamamad Raziin Zainal Abidin¹, Syarifah Nafisah Syed Hamzah Al-Yahya², Masaany Mansor³, Norazila Abdul Rahim⁴

Affiliations

¹ Department of Otorhinolaryngology, Hospital Al-Sultan Abdullah UiTM, Bandar Puncak Alam, Selangor, Malaysia. Electronic address: mraziin@uitm.edu.my.
² Department of Otorhinolaryngology, Hospital Al-Sultan Abdullah UiTM, Bandar Puncak Alam, Selangor, Malaysia. Electronic address: Synafisah@uitm.edu.my.
³ Department of Otorhinolaryngology, Hospital Al-Sultan Abdullah UiTM, Bandar Puncak Alam, Selangor, Malaysia; Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia. Electronic address: masaanymansor@uitm.edu.my.
⁴ Department of Otorhinolaryngology, Hospital Al-Sultan Abdullah UiTM, Bandar Puncak Alam, Selangor, Malaysia; Department of Otorhinolaryngology Head and Neck Surgery, Faculty of Medicine, Universiti Teknologi MARA (UiTM), Sungai Buloh, Selangor, Malaysia. Electronic address: norazila3587@uitm.edu.my.

Abstract

Introduction and importance: Cryptoccous infection or cryptococcosis is a severe opportunistic infection occurring mainly in immunocompromised patients. Laryngeal cryptococcus infection is rare. In an immunocompetent patient, inhaled corticosteroid was reported to be a possible risk factor.

Case presentation: We discuss a case of right vocal fold cryptococcus infection in a healthy, immunocompetent 71-year-old man with no history of inhaled corticosteroid, presented with hoarseness and intermittent aspiration symptom for 1 year duration. Further examination showed right anterior vocal fold mass with presence of right vallecular cyst.

Clinical discussion: Patient underwent direct laryngoscopy, excision of right vocal fold mass and marsupialization of vallecular cyst. Histopathological examination revealed cryptococcal infection. Patient subsequently treated with oral fluconazole 400 mg daily for 6 months. To date, hoarseness and aspiration symptoms have resolved.

Conclusion: We are sharing our experience in managing laryngeal cryptococcus infection in an immunocompetent patient where the associated risk factors discussed in previous literatures are absent.

Keywords: Case report; Immunocompetent; Laryngeal cryptococcus; Vallecular cyst; Voice Handicap Index-10.

Publication types

Case Reports