Invasive fungal laryngitis: A rare mimic of laryngeal cancer

Primary fungal laryngitis is a very rare clinical entity that usually manifests in immunocompromised patients due to impaired protection of the laryngeal mucosal barrier. We report a case of a 65-year-old patient with bilateral lung transplantation who presented with subacute worsening cough, hoarseness and clinical findings of hypercapnic respiratory failure. Initial imaging from barium swallow showed a mass narrowing the upper airway with a subsequent CT neck exam confirming a new large, invasive glottic mass narrowing the airway, which was initially suspicious for an aggressive malignancy. Prompt tracheostomy was performed and biopsies showed invasive fungal infection with sputum cultures that grew Ochroconis gallopava. The mass subsequently decreased in size after antifungal treatment. Diagnosis of fungal laryngitis can be overlooked as it can mimic laryngeal neoplasms as well as inflammatory/granulomatous processes or sequela of laryngopharyngeal reflux in milder cases. However, prompt diagnosis is critical given potential for invasion, risk of airway obstruction and loss of laryngeal function.