Clinically Suspected Fungal Laryngitis Masquerading as Laryngeal Carcinoma in a High-Risk Patient

Fungal laryngitis is an uncommon clinical entity that may radiographically and symptomatically mimic laryngeal malignancy, posing diagnostic challenges. We present the case of a 62-year-old male with a 40-pack-year smoking history, inhaled corticosteroid use, hypertension, diabetes mellitus, hepatitis C, and substance and alcohol abuse who presented with progressive hoarseness, sore throat, and dyspnea. Computed tomography (CT) revealed a laryngeal mass causing supraglottic airway narrowing, initially suggestive of carcinoma. Fiberoptic laryngoscopy demonstrated extensive white patches of the oropharynx, hypopharynx, and larynx. The patient showed significant clinical improvement following intravenous fluconazole and steroid therapy. Subsequent microsuspension laryngoscopy with biopsy revealed acute/chronic mucositis with reactive epithelial changes but no malignancy. Special stains (Periodic acid-Schiff (PAS), Grocott's Methenamine Silver (GMS), and Acid-Fast Bacilli (AFB)) were negative for fungi, though prior antifungal response supported the diagnosis. This case underscores the importance of considering isolated fungal laryngitis in high-risk patients with laryngeal masses to avoid misdiagnosis and unnecessary interventions.