Corticosteroids
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Fungal laryngitis: case report A 48-year-old woman with asthma developed fungal laryngitis during treatment with oral prednisone, inhaled salmeterol/fluticasone propionate, and intranasal budesonide [duration of treatments to reaction onset not clearly stated]. The woman presented to her doctor with persistent hoarseness, of 4–5 weeks duration. Over the previous 5 months, she had experienced episodes of bacterial sinusitis and an infective exacerbation of her asthma. These required treatment with oral prednisone [dosage not stated] and antibiotics for several weeks and were associated with transient hoarseness. Her asthma had been generally controlled well with medium-dose inhaled salmeterol/fluticasone propionate [dosage not stated], which she had received for many years. She had also been receiving intranasal budesonide 64µg daily for 2 years for rhinosinusitis symptom control. She was referred to an ear, nose, and throat (ENT) surgeon. Laryngoscopy revealed a small red nodule on her left vocal cord. Her hoarseness worsened and she returned to the ENT surgeon who conducted microlaryngoscopy. This showed that her left vocal cord was bulky and inflamed and was covered with white debris. A biopsy sample grew Cryptococcus and Aspergillus species. The woman was treated with itraconazole. However, her symptoms didn’t improve. The biopsy was repeated and, this time, a sample grew Candida species. Her treatment was changed to fluconazole and her hoarseness gradually resolved over the next 6 months. A respiratory physician recommended discontinuation of her intranasal and inhaled corticosteroids. At last follow-up, she had discontinued all her asthma drugs and was doing well. Author comment: "The patient’s risk factors for fungal laryngitis included long term inhaled corticosteroid use (both oral and intranasal), recent upper and lower respiratory tract infections, as well as several weeks use of oral prednisone." Morrison J. Persistent hoarseness - a case study. Australian Family Physician 40: 803069928 503-4, No. 7, Jul 2011 - Australia
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Reactions 5 May 2012 No. 1400
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