A Case of Laryngeal Actinomycosis and Mycosis

Actinomycosis is a systemic chronic bacterial infection caused by Actinomyces israelii, an anaerobic organism normally resident in the human mouth. It can involve any organ, but cervicofacial disease is the most common. On the other hand, in the field of otorhinolaryngology, fungal infection is usually detected in the ears, nasal sinuses, mouth, or pharynx, and the most common causative organisms are Aspergillus or Candida species. Involvement of the larynx, not only by actinomyces infection, but also by any fungal infection, is relatively rare. Herein, we present a case of co-infection with Actinomyces and Aspergillus in a 67-year-old male patient. The patient had a number of risk factors, including myelodysplastic syndrome, organizing pneumonia, old myocardial infarction, heart failure, heavy smoking, and oral steroid therapy. He presented with the complaints of sore throat and hoarseness after he got the ful. We recognized redness around the vocal cords at the first visit, and initiated the patient on treatment with acyclovir under the suspicion of varicella zoster virus infection. Although the condition seemed to improve initially, sulfur granules and thick white material eventually appeared in the larynx. Histopathological examination confirmed the diagnosis of actinomycosis and aspergillosis. The patient improved with penicillin plus antifungal drug therapy.
浜松医科大学医学部耳鼻咽喉科・頭頸部外科学教室 峯田周幸教授退任記念論文集～症例から学ぶ～
Festschrift for Professor Hiroyuki Mineta In Hornor of His Retirement as Chairman of Hamamatsu University School of Medicine