Over the course of a year, a man’s voice became progressively hoarser and his speech became shrill and grating, but he didn’t know why.
On examining the man, doctors discovered the reason: fungi were growing in his throat.
According to the report of the man’s case, published Thursday August 4 in the newspaper JAMA Otorhinolaryngology–Head and Neck Surgerythe man appeared otherwise healthy when he visited a clinic in Pennsylvania that treats head and neck conditions.
The man, in his 60s, said he had developed “hoarseness which gradually worsens” and shortness of breath over the past 12 months. His GP had previously treated him with inhaled corticosteroids – a standard treatment for asthma – but his symptoms had not improved.
To examine the man’s vocal cords and larynx, the hollow “voice box” that contains the vocal cords, doctors used a high-speed imaging technique called videostroboscopy. This examination revealed “severe” swelling of the tissues lining the patient’s throat, and this swelling had caused a narrowing of the airways.
Doctors also performed a biopsy on tissue from the man’s larynx and confirmed that the tissue was swollen, irregular and “friable” to the touch, meaning it tore easily.
Close examination of the sampled tissue revealed patches of dead laryngeal cells surrounded by clusters of immune cells, suggesting that the cells had died due to intense throat inflammation. The examination also revealed budding yeast cells, which immune cells had surrounded and begun to engulf.
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A diagnostic test identified the yeast as Blastomyces dermatitidisa fungus that causes an infection called blastomycosis.
B. dermatitis grows in outdoor environments, usually in moist soil and rotting wood and leaves, according to the Centers for Disease Control and Prevention (CDC).
In the United States, the species is particularly widespread in the regions surrounding the Ohio and Mississippi valleys, the Great Lakes and the St. Lawrence River.
People can develop blastomycosis after breathing B. dermatitis airborne spores, although most people exposed to the fungus do not get sick.
Having a weakened immune system increases the risk of infection, and those who become ill typically develop symptoms between three weeks and three months after breathing in the fungal spores.
Sometimes the infection can spread to the lungs, skin, bones, or central nervous system, which is the brain and spinal cord, according to the CDC.
In the case of the man, the fungus only developed in his larynx, which is quite unusual. “Laryngeal blastomycosis, first reported in 1918, is a rare extrapulmonary manifestation,” his doctors noted in the case report.
Due to the man’s severe airway obstruction, he underwent surgery to place a breathing tube in his trachea and a feeding tube placed in his stomach. He was given a long-term prescription for the antifungal drug itraconazole, and at a two-month follow-up appointment his hoarseness had improved significantly and his feeding tube was removed.
At a five-month follow-up, videostroboscopy revealed that the swelling in the man’s throat had diminished and his vocal cords had regained some mobility. At this point, his breathing tube was also removed.
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This article was originally published by Live Science. Read the original article here.