Laryngeal Candidiasis
A 78-year-old man with diabetes and chronic obstructive pulmonary disease (COPD) presented to the otolaryngology clinic with a 2-month history of dysphonia. For the past 10 years, he had used an inhaled glucocorticoid daily to manage his COPD. He had a history of tobacco use but no history of gastroesophageal reflux disease. On physical examination, the patient’s voice was hoarse. The oropharynx was normal. Fiberoptic laryngoscopy revealed white plaques on both vocal cords (Panel A). A biopsy sample obtained from one of the plaques showed hyperkeratinized stratified squamous epithelium and threadlike filaments that were positive for fungal presence on Grocott–Gomori methenamine silver staining (Panel B). A diagnosis of laryngeal candidiasis was made. Laryngeal candidiasis most commonly manifests with dysphonia. Predisposing factors include the use of inhaled glucocorticoids, gastroesophageal reflux disease, diabetes, and other immunocompromised states. Laryngoscopy is often necessary to make the diagnosis and to evaluate for other conditions, such as leukoplakia or malignant disease. The patient received treatment with a course of fluconazole. At a 2-week follow-up visit, his voice had normalized and the laryngoscopic findings had improved. Mariko Koike-Ieki, M.D. University of Tokyo Hospital, Tokyo, Japan source:nejm.org