A VERY RARE CASE OF LARYNGEAL CRYPTOCOCCOSIS

TOPIC: Occupational and Environmental Lung Diseases TYPE: Fellow Case Reports INTRODUCTION: Infections caused by Cryptococcus neoformans occur mainly in immunocompromised hosts, most commonly present either as primary lower respiratory infections or secondary disseminated processes. Isolated laryngeal cryptococcosis is a rare clinical entity with few cases reported medical literature. We are presenting an interesting case of patient high-dose inhaled corticosteroid use wood worker. CASE PRESENTATION: An 85-year-old male history diabetes mellitus chronic obstructive pulmonary disease presented four-month unexplained dysphonia. Patient ex-smoker. He welder worker for many years had no exposure to birds. Patient's regimen included formoterol (9mcg) budesonide (320 mcg), taken twice daily. was seen otolaryngology clinic, where flexible laryngoscopy noted mild cobblestoning the pharynx. Vocal cord motion normal, but vocal folds demonstrated extensive thick white plaque erythema bilaterally. Biopsy done revealed marked acute inflammation, ulceration necrosis. PAS-D, GMS mucicarmine stains highlighted numerous fungal organisms compatible cryptococcus. Fungal culture also grew cryptococcus neoformans. Serum Cryptococcal antigen HIV were negative. CT chest MRI brain both normal. started on fluconazole 200mg daily, adjusted his kidney function. Inhaled discontinued. Counseling safe occupational provided. In 3-month follow up, dysphonia has significantly improved, yet completely resolved. Plan continue therapy at least 6 months. DISCUSSION: immunocompetent patients isolated disease, role localized immunosuppression disruption mucosal barrier important. Factors described causing such include previous radiotherapy, gastroesophageal reflux, traumatic intubation, smoking, corticosteroids. The association between certain trees eucalyptus rotting been reported. showed significant improvement oral therapy. literature, low doses have failed eradicate infection some cases. decision dose reduction stopping it should be made case-by-case basis, based severity patient's status. CONCLUSIONS: Laryngeal cryptococcosis, despite its rarity, important condition consider risk factors. Detailed environmental pertinent. Tissue biopsy essential make diagnosis rule out possible malignancy. cryptococcal readily treatable prolonged antifungals once histopathological confirm diagnosis. REFERENCE #1: Wong DJY, et al. Cryptococcosis Associated With Corticosteroid Use: Literature Review. Front Surg. 2017;4:63. Published 2017 Nov 13. doi:10.3389/fsurg.2017.00063 #2: Bergeron M, Primary Larynx Infection: A Distinctive Clinical Entity. Open Forum Infect Dis. 2015;2(4):ofv160. 2015 Oct 26. doi:10.1093/ofid/ofv160 #3: Mittal N, larynx: report. J Laryngol Otol. 2013 Jul;127 Suppl 2:S54-6. doi: 10.1017/S0022215113000522. DISCLOSURES: No relevant relationships Omar Abdulfattah, source=Web Response Zainab Alnafoosi, Muath Alsharif,