Laryngeal Histoplasmosis in a Non-Endemic Region: A Diagnostic Challenge.
John J Alfarone, Evan B Hughes, Shridevi D Karikehalli et al.
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Case in brief
A 40-year-old immunosuppressed man receiving a TNF-α inhibitor presented with progressive dysphagia, hoarseness, and weight loss in a non-endemic region. Laryngoscopy showed verrucous supraglottic lesions, and imaging suggested neoplastic or granulomatous disease. Biopsy with fungal staining identified Histoplasma capsulatum. Oral itraconazole did not control the infection; treatment was escalated to intravenous amphotericin B, followed by long-term oral antifungal therapy. Infliximab was discontinued, and multidisciplinary follow-up accompanied full clinical resolution.
What made this case unusual
Laryngeal histoplasmosis presented as verrucous lesions concerning for malignancy in a patient living outside an endemic region and receiving TNF-α inhibitor therapy.
Diagnostic / clinical pearl
When laryngeal lesions mimic malignancy, biopsy with fungal staining can distinguish histoplasmosis from neoplastic or granulomatous disease, including in patients outside endemic regions.
Why it matters
TNF-α inhibitor use may increase susceptibility to disseminated fungal infection, making histoplasmosis a relevant consideration in immunosuppressed patients.