fluticasone and Aspergillosis

Primary laryngeal aspergillosis is extremely rare, especially in an immunocompetent host. It is commonly found as a part of systemic infection in immunocompromised patients. A case of vocal cord aspergillosis with no systemic extension in an immunocompetent patient on long-term steroid metered dose inhaler (MDI) is presented here, because of its rarity. The present case is a 28-year-old asthmatic female who was on inhalational steroid for 8 years, presented with sudden onset of severe dysphonia for 5 days. Fiberoptic laryngoscopy demonstrated whitish plaque involving right vocal cord, clinically suggestive of fungal laryngitis. Microlaryngeal laser surgery was performed with stripping of the plaque. Histopathology demonstrated ulcerated hyperplastic squamous epithelium with masses of fungal hyphae, which was confirmed to be Aspergillus species on fungal culture. This rare but serious adverse effect of long-term steroid MDI use must be kept in mind while treating an asthmatic patient. We also present a brief review of literature of laryngeal aspergillosis.

Topics: Administration, Inhalation; Adult; Aspergillosis; Asthma; Female; Fluticasone; Humans; Laryngeal Diseases; Vocal Cords

Iatrogenic Cushing's syndrome is an undesirable outcome of glucocorticoids treatment. It can be increased by pharmacologic interactions. Glucocorticoid therapy, given in association with ritonavir, and some azole treatments are causes of iatrogenic Cushing's syndrome. We present a patient with common-variable immunodeficiency who received 7 years of itraconazole therapy for bronchial colonization with Aspergillus in combination with inhaled fluticasone without any Cushingoid symptoms. After a switch to posaconazole, the patient developed Cushingoid symptoms.

Topics: Androstadienes; Antifungal Agents; Aspergillosis; Bronchi; Bronchodilator Agents; Common Variable Immunodeficiency; Cushing Syndrome; Female; Fluticasone; Humans; Iatrogenic Disease; Itraconazole; Middle Aged; Triazoles

Aspergillus is a ubiquitous mold that can cause several types of symptomatic infections: allergic aspergillosis, typically in young atopic patients; aspergillomas (often referred to as fungus balls); and invasive aspergillosis, typically seen in debilitated or immunocompromised patients. We describe an 85-year-old woman who was not immunocompromised but had invasive aspergillosis of the paranasal sinus that resulted in unilateral headache and retrobulbar optic neuropathy. After extensive differential diagnostic examination, we concluded that the condition was possibly related to the long-term use of nasal corticosteroids (fluticasone propionate aqueous nasal spray). Surgical removal of solid masses of Aspergillus organisms followed by extended treatment with antifungal agents resulted in a favorable outcome.

Topics: Administration, Topical; Aged; Aged, 80 and over; Androstadienes; Anti-Inflammatory Agents; Aspergillosis; Female; Fluticasone; Glucocorticoids; Headache; Humans; Optic Nerve Diseases; Paranasal Sinus Diseases; Tomography, X-Ray Computed

Topics: Administration, Inhalation; Adrenal Insufficiency; Adult; Androstadienes; Anti-Asthmatic Agents; Anti-Inflammatory Agents; Aspergillosis; Asthma; Fluticasone; Humans; Lung Diseases, Fungal; Male

The case history is presented of a 75 year old man with chronic asthma who was treated with inhaled fluticasone propionate in a daily dose of 2 mg using a Diskhaler. After three years of treatment he developed progressive hoarseness. Both vocal cords were colonised by Aspergillus fumigatus which formed a white slough on the surface. Biopsy specimens showed changes suggestive of laryngeal aspergillosis with an ulcerated epithelium, fibrinopurulent debris, and colonies of fungal hyphae. A slow recovery occurred after three months of treatment with topical amphotericin and with cessation of inhaled corticosteroids. Laryngoscopy is recommended if hoarseness occurs during treatment with fluticasone.

Topics: Administration, Topical; Aged; Androstadienes; Anti-Inflammatory Agents; Aspergillosis; Aspergillus fumigatus; Asthma; Fluticasone; Glucocorticoids; Humans; Laryngeal Diseases; Male