Case Report Primary Aspergillosis of the Larynx Richard H. Law and Samuel A. Reyes Department of Otolaryngology, University at Bufalo School of Medicine and Biomedical Sciences (SUNY), 1237 Delaware Avenue, Bufalo, NY 14209, USA Correspondence should be addressed to Richard H. Law; rlaw@bufalo.edu Received 11 September 2015; Accepted 18 January 2016 Academic Editor: Kamal Morshed Copyright © 2016 R. H. Law and S. A. Reyes. Tis is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Laryngeal aspergillosis is most commonly seen as a result of secondary invasion from the lungs and tracheobronchial tree in immunocompromised hosts. Primary aspergillosis of the larynx is, however, rare with few cases documented over the past ffy years. We report a case of a 73-year-old woman who presented with persistent hoarseness. She is a nonsmoker with a history of asthma and chronic bronchiectasis treated with bronchodilators, inhaled and oral corticosteroids, and nebulized tobramycin. Direct laryngoscopy with vocal cord stripping confrmed the diagnosis of invasive aspergillosis with no manifestations elsewhere. Te patient was successfully treated with oral voriconazole with no signs of recurrence. Although several major risk factors contributing to the development of primary aspergillosis of the larynx have been discussed in the literature, there has been no mention of inhaled antibiotics causing this rare presentation to the best of our knowledge. We, therefore, highlight the use of inhaled tobramycin as a unique catalyst leading to the rapid onset of this rare presentation. 1. Introduction Disseminated invasive aspergillosis is most commonly asso- ciated with immunocompromised states such as AIDS, malignancies, aplastic anemia, chemotherapy, radiation, immunosuppressants, and genetic disorders of the immune system [1]. Aspergillus has very little pathogenic capability in a healthy host; however, it can cause major morbidity and mortality in compromised hosts [2, 3]. It gains access to the respiratory mucosa via inhalation (spores) with subse- quent invasion causing necrosis, ulceration, hemorrhage, and thrombosis. In immunocompromised hosts, there is ofen hematogenous seeding involving multiple organs such as the lungs, brain, heart, kidneys, spleen, gastrointestinal tract, and lymph nodes [4–6]. Despite its opportunistic nature, Aspergillus can also cause localized/primary disease in relatively healthy patients with the external auditory canal, paranasal sinuses, and orbit being the most common sites afected [2, 4, 5, 7]. Primary aspergillosis of the larynx is, however, extremely rare when compared to the incidence of primary aspergillosis afecting other sites within the head and neck. As a result, this unique presentation may be mistaken for malignancy of the vocal folds initially. Te exact mechanism of primary aspergillosis of the larynx is still unclear but is most likely multifactorial. 2. Case Report Te patient is a 73-year-old woman who was referred by her pulmonologist for persistent hoarseness, which began afer starting nebulized tobramycin nine months earlier. She is a nonsmoker with a history of asthma and chronic bronchiec- tasis treated with inhaled ipratropium bromide/albuterol, oral prednisone, and an inhaled combination of budesonide and formoterol, prior to starting nebulized tobramycin. She did not have any malignancies or other known active infec- tions. CRP, ESR, CBC with diferential, serum immunoglob- ulins, and Aspergillus immunoglobulins were negative. On exam, there were no visible lesions or masses in the oral cavity as well as the oropharynx and nasopharyngeal mucosa. Tere was no evidence of cervical lymphadenopathy or palpable masses in the neck. Her voice was noted to be hoarse with a whisper-like quality. Hindawi Publishing Corporation Case Reports in Otolaryngology Volume 2016, Article ID 1234196, 3 pages http://dx.doi.org/10.1155/2016/1234196