14th International AIDS Conference Barcelona, Spain - July 7-12, 2002

Int Conf AIDS 2002 Jul 7-12; 14:(abstract no. B10252)

Gulotta H, Olenchuk A, Dure R, Bava J, Troncoso A
Infectious Diseases Francisco Muniz Hospital, Buenos Aires, Argentina

BACKGROUND: Laryngeal Histoplasmosis was first described in 1952. Since then, fewer than 100 cases had been reported.

METHODS: We report a 30-year-old woman, IDU, with prolonged fever > 102 F persisting > 6 weeks, weight loss, disphagia, upper respiratory symptoms who developed laryngitis with dyspnoea, dysnea, cough and airway obstruction.

RESULTS: The Video-assisted-laryngoscope showed: a mass in larynx, which reduces the light significantly. The markedly abnormal larynx lesions, which could have been mistaken for neoplasm, was biopsies. At least two biopsy specimens were obtained from the lesion. They were fixed in 10% formalin and stained with Hematoxylin and Eosin(H&E), Azur II, Giemsa and acid-fast organism. Pathological examination of the laryngeal biopsy specimen showed inflammatory infiltrate lesions without caseating necrosis and confirmed the presence of Histoplasma capsulatum. CD4+ cell count 25 cells/mm³-3.2%, HIV RNA: 86.000 cp/mm³.

CONCLUSIONS: Cases of HIV-associated disseminated histoplasmosis occurring in-patients with advanced immunosuppression and presenting with laryngeal affectation tends to be relatively less common in the highly active antiretroviral therapy (HAART) era. Within the upper aerodigestive tract, histoplasmosis often mimics carcinoma or tuberculosis, making prompt and accurate diagnosis imperative. Histoplasmosis is a fungal infection which when is laryngeal can be potentially lethal especially when not early diagnosed and correctly treated. The Histoplasmosis should be included in the differential diagnosis of laryngeal diseases in immunocompromised patients. As the number of HIV positive patients without antiretroviral treatment continues to increase in modern clinical practice, Histoplasmosis will undoubtedly be encountered more frequently in the laryngeal area. A high index of suspicion and diagnosis with biopsy is needed. Early treatment can reduce morbidity and mortality.

020707
B10252

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