A man with seemingly no other medical problems discovered that his hoarse throat was caused by a fungus growing inside him.
A new medical case report has described how a man in his sixties noticed that over the course of a year, his voice had grown more and more hoarse, while he also began to experience shortness of breath. Despite investigations into his medical history, there was no obvious cause for the problems.
"He denied any history of dysphagia, odynophagia, fevers, unintentional weight loss, cough, or reflux symptoms," his doctors wrote in the journal Otolaryngology – Head and Neck Surgery, adding that previous treatment for asthma made no difference to his condition.
"There was no prior history of smoking, head and neck surgeries, or radiation exposure."
And yet he was "considerably" hoarse, as well as short as breath. Unfortunately for the man, the answer was a fungus.
A computed tomographic (CT) scan of his neck revealed "irregularity" along the vocal folds, before a high-speed medical imaging method known as videostroboscopy found swelling in his throat's tissue, and a tissue sample showed signs of tissue death resulting from inflammation. The culprit was also found: a yeast surrounded by immune cells.
Blastomyces dermatitidis is a dimorphic fungus, meaning that it can exist as a mold in the environment and as a yeast inside hosts, including the subject of the report. Blastomycosis – the infection caused by the fungus – is mostly seen in the Great Lakes and Mississippi-Ohio River valley region, according to the authors, and is mainly acquired through breathing in aerosolized particles from disturbed soil. The infection can affect the skin, bones, genitals, and central nervous system of the host, but most commonly – as here – it affected the pulmonary system.
Unfortunately, due to the relative rareness of the disease (approximately 1 to 2 cases per 100,000 people in the US and Canada), there isn't much evidence-based treatment out there for it. However, most cases will resolve with the anti-fungal medication itraconazole, as was prescribed here. Due to the blockage of his airways, he was given a tracheotomy to assist his breathing.
Two months after his admission, the patient was less hoarse, and five months after admission his vocal cords had improved and the swelling in his throat diminished.