Invasive Fungal Laryngotracheitis Causing Laryngotracheal Separation

Area of Science:

• Infectious Diseases
• Otolaryngology
• Critical Care Medicine

Background:

• Fungal laryngotracheitis (FLT) is a rare condition with non-specific symptoms, often mimicking other serious diseases.
• Early diagnosis and intervention are crucial due to FLT's potential for invasive complications, including airway obstruction and laryngeal dysfunction.

Observation:

• A 39-year-old diabetic woman presented with sore throat, hoarseness, dysphagia, and stridor, initially managed for diabetic ketoacidosis and tonsillopharyngitis.
• Intubation was required for airway compromise. Subsequent assessment revealed bilateral vocal fold edema, subglottic pus, and tracheal fluid, with CT showing a distorted larynx and peritracheal fluid.

Findings:

• Histopathology confirmed a fungal infection, specifically Candida guillermondii with Escherichia coli.
• Initial treatment with fluconazole and cefuroxime led to clinical improvement, but a non-functioning larynx persisted, initially suggesting total laryngectomy.
• Multidisciplinary discussion favored continued antifungal therapy, leading to patient stability and oral intake tolerance with a tracheostomy.

Implications:

• This case emphasizes the importance of maintaining a high index of suspicion for FLT in patients with severe upper airway symptoms.
• It highlights the need for individualized treatment strategies, particularly regarding surgical intervention like total laryngectomy, in cases of non-functioning larynx secondary to fungal infections.
• Successful conservative management with antifungal therapy demonstrates the potential to avoid radical surgery in select FLT cases.