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 par acoccidioidomycosis diagnosed by histopathological examination. Main Outcome Measure: Clinical manifestations of laryngeal paracoccidioidom ycosis. Results: All patients were men and were middle-aged (range, 43-65 years), a nd most (86% [6/7]) were farm workers. All 7 patients regularly used tobacc o, but only (43% [3/7]) were alcohol users. Clinical manifestations were dy sphonia (86% [6/7]), dyspnea (71% [5/7]), dysphagia (43% [3/7]), and cough (29% [2/7]). Laryngeal examination revealed ulcerative lesions with a mulbe rry-like appearance in 3 patients and vegetative lesions in 4 patients. Man y had multiple laryngeal lesions with involvement of the true and false voc al cords, the epiglottis, and the arytenoid and interarytenoid areas. The f irst 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 revea l lesions similar to laryngeal cancer; therefore, diagnosis of carcinoma mu st be ruled out by histopathological examination or culture of a specimen.