Laryngeal manifestations of paracoccidioidomycosis (South American blastomycosis)

Objective: To report clinical manifestations, diagnosis, and epidemiologic characteristics of laryngeal paracoccidioidomycosis. Design: Case series. Settings: Tertiary care institutional hospital. Patients: We reviewed the hospital records of 7 patients with laryngeal paracoccidioidomycosis diagnosed by histopathological examination. Main Outcome Measure: Clinical manifestations of laryngeal paracoccidioidomycosis. Results: All patients were men and were middle-aged (range, 43-65 years), and most (86% [6/7]) were farm workers. All 7 patients regularly used tobacco, but only (43% [3/7]) were alcohol users. Clinical manifestations were dysphonia (86% [6/7]), dyspnea (71% [5/7]), dysphagia (43% [3/7]), and cough (29% [2/7]). Laryngeal examination revealed ulcerative lesions with a mulberry-like appearance in 3 patients and vegetative lesions in 4 patients. Many had multiple laryngeal lesions with involvement of the true and false vocal cords, the epiglottis, and the arytenoid and interarytenoid areas. The first diagnostic impression was carcinoma in all patients. Conclusions: Laryngeal paracoccidioidomycosis may be a difficult diagnosis for the unsuspecting clinician to make. Examination of the larynx can reveal lesions similar to laryngeal cancer; therefore, diagnosis of carcinoma must be ruled out by histopathological examination or culture of a specimen.