Primary Histoplasmosis of Larynx Mimicking as Laryngeal Carcinoma

Granulomatous diseases caused by infectious agents are being encounted more frequently nowadays. Infection by Histoplasma capsu latum is one such granulomatous disease. Isolated laryngeal histoplasmosis is a rare clinical entity. Because of its simulation with malignancy, it needs to be included in the diffe rential diagnosis of neoplasm, both benign and malignant. We report an extremely rare case of isolated histoplasmosis, presenting as a primary infection of the larynx with no other systemic involvement in a 57 years old immunocompetent male. He presented with progressive hoarseness of voice, difficulty in breathing and mild dysphagia. Indirect laryngoscopy revealed multiple exophytic nodular lesions in endolaryngeal structures. The patient then underwent direct laryngoscopy biopsy under general anesthesia and the histopathological examination of the biopsy revealed chronic granulomatous inflammation, caused by histoplasma which was confirmed by using special Gomori’s methanamine silver stain for fungi. Though it appeared like cancer clinically; biopsy confirmed the final diagnosis. The histopathologist must be informed about the possibility of histoplasmosis, because special dyes have to be used to confirm this diagnosis. The treatment is mainly medical with amphotericin B which remains the gold standard for treatment of this disease, although other drugs have also been used.