Laryngeal histoplasmosis mimicking glottic cancer in an immunocompetent host

We report an interesting case of laryngeal histoplasmosis which clinically mimicked a malignant glottic growth and is unusual in that it involved an immunocompetent host. Also, an isolated laryngeal involvement is very rare. A 63 year old farmer presented with complaints of hoarseness of voice. Indirect layngoscopy revealed a friable growth in the middle of the right vocal cord. Histopathological examination of biopsy taken from the growth showed presence of numerous tiny intracellular organisms within collections of macrophages and epithelioid cells. Confirmation was done with periodic acid Schiff and Gomori’s methanamine silver stain. The patient was administered amphotericin B 1 mg/kg body weight for 2 weeks followed by itraconazole 200 mg, twice a day for 8 weeks and discharged on oral itraconazole. A dramatic improvement in voice quality was seen in follow-up after two months. Repeat endoscopy showed regression of growth. The otolaryngologist should be aware of the existence of laryngeal histoplasmosis and consider it as one of the differential diagnosis when a patient shows signs of granulomatous inflammation or laryngeal masses, to perform specific diagnostic tests for fungi and provide optimal and timely treatment, avoiding unnecessary aggressive interventions.