Infectious granulomatous laryngitis: a retrospective study of 24 cases

The diagnostic and treatment of verrucous lesions of the larynx involves a high level of suspicion by the physician attending the patient. The causes may go from unspecific laryngitis to neoplasia and granulomatous diseases. This kind of lesion is uncommon and the presentation aspects may vary broadly. The lesions in larynx are significant source of morbidity. The onset of symptoms is insidious and the diagnosis is usually delayed. Symptoms include dysphonia, dyspnea, dysphagia and odynophagia. Proper treatment depends upon tissue biopsy, identification of the causative organism, and the appropriate pharmacotherapy. As there are few papers presenting the clinical features of infectious granulomatous laryngitis (IGL) as leishmaniasis, tuberculosis and paracoccidiodomycosis affecting the larynx, we considered important to show the experience of a big Brazilian Laryngology Service in dealing with this potential worldwide problem. We present a retrospective chart review showing our institution's experience with IGL focusing in the diagnostic, treatment and prognosis aspects. Twenty-four patients were identified. Mycobacterium tuberculosis and Paracoccidiodis brasiliensis accounted for ten cases each, and Leishmania braziliensis the remaining four. Hoarseness was the most common symptom of infection. Up to one-third of patients with laryngeal involvement lacked laryngeal symptoms. The average delay from onset of symptoms to diagnosis was 7 months. All patients underwent direct laryngoscopy and biopsies. Caseating granulomas was the key histopathologic finding. Identification of the causative organism was uncommon. No evidence of concomitant malignancy was seen on biopsy. Despite treatment, almost 40% of patients had permanent sequelae of infection, including hoarseness, dyspnea, and dysphagia. Mycobacterium tuberculosis, P. brasiliensis, and L. braziliensis accounted for all cases of IGL. Patients may have laryngeal infection but lack laryngeal symptoms. Prompt diagnosis relies upon a high index of suspicion, especially when evaluating patients from endemic areas. Given the degree of tissue destruction, which accompanies infection, timely intervention may be important in the prevention of late sequelae. Despite appropriate therapy, a significant number of patients may have permanent sequelae of infection.