A thorough medical examination of a man suffering from persistent hoarseness and breathing difficulties for many months revealed that fungi had been growing in his throat.
A severe fungal infection
The 60-year-old from Pennsylvania visited a clinic in the state treating head and neck conditions, explaining that inhaled corticosteroids (standard treatment for asthma) prescribed by his treating doctor had not resulted in any improvement of his symptoms.
Examination of his vocal cords and larynx using a high-frequency imaging technique called videostroboscopy revealed severe swelling of the tissue lining his throat, causing a narrowing of the airways. A biopsy of the larynx revealed the presence of budding cells of Blastomyces dermatitidis (mushroom causing an infection called blastomycosis), which immune cells had surrounded and started to devour, leading to intense inflammation.
Fungal species endemic to North America, B. dermatitidis thrives in natural environments, usually in moist soil, wood and decaying leaves. Although most people exposed to this fungus do not get sick, it is possible to develop blastomycosis following breathing in the spores of B. dermatitidis suspended in the air.
According to the Centers for Disease Control and Prevention (the lead US federal agency for protecting public health), a weakened immune system increases the risk of infection, and people who get sick usually develop symptoms between three weeks and three months following breathing in the fungus spores. Sometimes the infection can spread to the lungs, skin, bones, or central nervous system (brain and spinal cord).
Laryngeal blastomycosis
In the case of this man, recently described in the journal JAMA Otolaryngology-Head & Neck Surgery, the fungus only grew in his larynx, which is quite unusual. ” Laryngeal blastomycosis, first reported in 1918, is a very rare extrapulmonary manifestation “, note the authors of the report.
Due to severe airway obstruction, the man underwent surgery to place a breathing tube in his trachea and a feeding tube in his stomach, and was given a long-term prescription for medication antifungal, itraconazole.
Symptoms improved following two months and her feeding tube was removed. At the five-month follow-up, video stroboscopy revealed that the swelling in her throat had clearly diminished and that her vocal cords had regained some mobility. At this time, the breathing tube was also removed.