Subglottic abscess: an unusual presentation of laryngeal candidiasis

This case report details an unusual presentation of laryngeal candidiasis in an elderly and immunocompetent man who attended the emergency department with stridor, dysphagia and sore throat due to a subglottic lesion that was subsequently revealed to be an abscess. Conservative management with antibiotics and steroids was initiated. His airway deteriorated, necessitating tracheostomy under local anaesthetic, microlaryngoscopy, incision and drainage of the left subglottic collection and biopsy of the left subglottic region. Biopsies showed no evidence of neoplasia, and intraoperative pus swabs grew Candida albicans At follow-up, flexible nasal endoscopy revealed classic signs of laryngeal candidiasis and the patient was prescribed a 2-week course of fluconazole which resolved these appearances and left the patient asymptomatic and clinically well since. Although laryngeal candidiasis typically presents in immunocompromised patients with erythema, oedema and white plaques on endoscopy, it may also affect immunocompetent hosts and present with atypical lesions such as a subglottic abscess.