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• W2000986518 abstract "To the Editors: Aspergillus fungi are ubiquitous in the environment. They colonize the respiratory tract through inhalation of airborne species. We describe an extremely rare case of primary laryngeal aspergillosis in a 2-year-old boy complicating chemotherapy for acute lymphoblastic leukemia (ALL). A 2-year-old boy with common acute lymphocytic leukemia was treated with standard risk BFM95 chemotherapy protocol. During the induction therapy and on the 6th day of febrile neutropenia, he developed hoarseness and inspiratory stridor. A chest radiograph was normal. An initial diagnosis of viral laryngotracheobronchitis was made, and the patient was managed with nebulized adrenaline and corticosteroids. The condition of the patient did not improve, prompting flexible laryngoscopy. This revealed a pale plaque on the right vocal cord. Because of subglottic narrowing and edema, tracheostomy was performed. The biopsy of the specimen showed inflammatory and necrotic cells and numerous fungal hyphae. Tissue culture grew Aspergillus fumigatus. Treatment was begun with liposomal amphotericin (2 mg/kg/d). Despite antifungal treatment, Aspergillus infection expanded, and signs of pulmonary aspergillosis (2 excavations with the air crescent sign located in the right upper and median lobe) were shown on chest computerized tomography scan 20 days later. Bronchoalveolar lavage, which was sent for polymerase chain reaction-based and antigen detection of Aspergillus with enzyme-linked immunosorbent assay confirmed the diagnosis of Aspergillus laryngotracheobronchitis. He continued to receive antifungal treatment with liposomal amphotericin (5 mg/kg/d), and 3 months later chest computerized tomography scan showed improvement of the radiologic findings. The child 2 years later is receiving maintenance treatment without recurrence of the laryngeal aspergillosis. Invasive aspergillosis is a common opportunistic fungal infection in immunocompromised patients, but primary aspergillosis of the larynx is extremely rare.1 The review of literature revealed fewer than 20 cases of adults, with the majority cases in healthy subjects with primary laryngeal aspergillosis without invasion.2 The remaining cases were reported in immunocompromised patients or in patients who had received local radiotherapy for vocal cord carcinoma.3–4 In children, only 1 other case was reported by Barnes et al.5 It concerned a case of a 6-year-old girl with acute lymphoblastic leukemia who developed Aspergillus laryngotracheobronchial infection after a cord blood transplantation. Their patient, like ours, was initially misdiagnosed as having acute viral laryngotracheobronchitis and was managed with corticosteroids. In our case, diagnosis was not delayed because of the early performance of laryngoscopy, which revealed the white to yellow plaque on the right vocal cord. It is still uncertain whether the tracheostomy helped in spreading Aspergillus into the lower respiratory tracts. Fani Athanassiadou, MD, PhD Maria Kourti, MD, MSc Theodotis Papageorgiou, MD, PhD Second Department of Pediatrics Division of Hematology and Oncology John Danielidis, MD, PhD Department of Otorhinolaryngology AHEPA University Hospital Aristotle University of Thessaloniki Thessaloniki, Greece" @default.
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• W2000986518 date "2005-02-01" @default.
• W2000986518 modified "2023-09-27" @default.
• W2000986518 title "Invasive Aspergillosis of the Larynx in a Child With Acute Lymphoblastic Leukemia" @default.
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• W2000986518 doi "https://doi.org/10.1097/01.inf.0000153171.16525.28" @default.
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