A69-09 A Case of Aspergillosis Fumigatus Infection of the Vocal Cords in a Patient With Prior Laryngeal Malignancy

Aspergillus fumigatus is a common fungus found in soil, food, water, and household dust. It spreads through inhalation of airborne spores and typically causes invasive pulmonary infections in immunocompromised individuals, including those with underlying lung disease, neutropenia, prolonged corticosteroid use, organ transplant recipients, and hematological malignancies. Symptoms of invasive pulmonary aspergillosis can include fever, dyspnea, cough, and pleuritic chest pain. This case report describes an unusual presentation of Aspergillus fumigatus infection in the vocal cords of a male patient with predisposing risk factors. A 78-year-old male with a history of pulmonary fibrosis, COPD, forty-five pack year smoking history, thyroidectomy for Graves’ Disease, and right vocal cord squamous cell carcinoma treated with radiation in 2023, presented to the hospital with acute on chronic respiratory failure after a recent hospitalization for pneumonia and worsening pulmonary fibrosis. His home medications included albuterol, budesonide-formoterol, levothyroxine, and nintedanib. During his prior hospitalization, he required mechanical ventilation, five days of Unasyn, and management for supraglottic edema using racemic epinephrine, Decadron, and Heliox. He improved, was extubated, and discharged home. The patient was readmitted shortly after his discharge due to recurrent respiratory failure manifested by tachypnea, stridor, and airway narrowing, ultimately requiring reintubation and mechanical ventilation. CT angiography revealed findings of interstitial pulmonary fibrosis and consolidation within the right middle lobe. During the second hospitalization, flexible video laryngoscopy revealed hypomobile vocal cords, mild arytenoid edema, and pooling saliva. Direct laryngoscopy showed necrotic left vocal cord and abnormal mucosa of the right posterior vocal cord. He underwent tracheostomy placement. Vocal cord biopsies were collected and the histopathology revealed moderate dysplasia, necrotizing inflammation, and septate fungal hyphae with necrotic cartilage. The results were consistent with aspergillus fumigatus. There was no evidence of malignancy. His tracheal aspirate culture grew aspergillus fumigatus. The patient’s CBC, metabolic panel, blood cultures, and Respiratory PCR Panel were negative. Voriconazole 200 mg BID for 12 weeks was prescribed and led to clinical improvement. Laryngeal Aspergillus Fumigatus infections are rare. Previous case reports have suggested that patients with a history of laryngeal carcinoma treated with radiation or the presence of vocal cord cysts may increase the risk of developing aspergillus fumigatus vocal cord infection. The patient’s supraglottic narrowing, airway edema, and stridor were likely exacerbated by the fungus. This case highlights the importance of considering laryngeal aspergillosis fumigatus as a potential diagnosis and testing for the infection in patients with relevant risk factors and presenting symptoms. This abstract is funded by: None