Isolated vocal cord aspergillosis in an immunocompetent 60-year-old woman: A rare case report with radiological findings

Laryngeal aspergillosis is an uncommon manifestation of Aspergillus infection and is most frequently described in immunocompromised patients or in association with pulmonary or systemic disease. Isolated involvement of a vocal cord in an immunocompetent patient is particularly rare and may mimic a neoplastic or inflammatory laryngeal lesion. We report the case of a 60-year-old immunocompetent woman presenting with a four-month history of progressive hoarseness, throat discomfort, and intermittent globus sensation. Flexible laryngoscopy revealed a raised whitish-yellow exophytic lesion involving the middle third of the right true vocal cord, with preserved vocal cord mobility. Contrast-enhanced computed tomography (CT) of the neck demonstrated focal soft-tissue thickening of the right vocal cord measuring approximately 12 × 9 mm, without paraglottic extension, thyroid cartilage erosion, or cervical lymphadenopathy. The lesion was surgically excised. Histopathological examination demonstrated septate fungal hyphae with acute-angle branching, compatible with Aspergillus species. Fungal culture identified Aspergillus flavus . The patient had no identified immunodeficiency or other recognized predisposing condition. She was treated with oral itraconazole 200 mg twice daily for three weeks, with progressive clinical improvement and complete endoscopic resolution at three months. No recurrence was observed during six months of follow-up. Isolated vocal cord aspergillosis should be considered in the differential diagnosis of persistent hoarseness and focal vocal cord lesions, even in immunocompetent patients. CT is useful for defining the extent of laryngeal involvement and, particularly, for evaluating deep tissue extension, cartilage invasion, and cervical lymphadenopathy. However, imaging findings are nonspecific, and definitive diagnosis requires histopathological and microbiological confirmation.