New Case Report Vocal Cord Actinomycosis Mimicking a Laryngeal...

Hindawi Publishing CorporationCase Reports in OtolaryngologyVolume 2013, Article ID 361986, 2 pageshttp://dx.doi.org/10.1155/2013/361986

Case ReportVocal Cord Actinomycosis Mimicking a Laryngeal Tumor

Keisuke Yoshihama,1 Yasumasa Kato,2 and Yuh Baba1,2,3

1 Department of Otolaryngology, Nasu Red Cross Hospital, 1081-4 Nakatahara, Otawara City, Tochigi 324-8686, Japan2Department of Oral Function and Molecular Biology, Ohu University, 31-1 Misumido, Tomita-machi, Koriyama City,Fukushima 963-8611, Japan

3Department of Otolaryngology, Keio University, 35 Shinano-machi, Shinjuku, Tokyo 160-8582, Japan

Correspondence should be addressed to Yuh Baba; yuh baba@hotmail.com

Received 31 January 2013; Accepted 28 February 2013

Academic Editors: K. Morshed and H.-W. Wang

Copyright © 2013 Keisuke Yoshihama et al. This is an open access article distributed under the Creative Commons AttributionLicense, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properlycited.

Laryngeal carcinoma and laryngeal papilloma are the most commonly encountered tumorous lesions in the larynx. Herein, wereport a case of the mass arising from the left vocal cord in a 49-year-old Japanese man. Endoscopic examination suggested that themass is a tumor such as carcinoma and papilloma. Pathological examination showed that the specimen demonstrated actinomycosisin the left vocal cord. Although vocal cord actinomycosis is extremely rare, the otolaryngologist should recognize this conditionduring the inspection of the larynx.

1. Introduction

Laryngeal carcinoma and laryngeal papilloma are the mostcommonly encountered tumorous lesions in the larynx.Actinomycosis is a disease that is mainly caused by Acti-nomyces israelii. Actinomyces israelii is an anaerobic, Gram-positive organism that is normally present in the oral cavity.Clinical manifestation mainly occurs in one of three forms:cervicofacial, abdominal-pelvic, or pulmonary actinomyco-sis. However, the actinomycosis of the larynx is very rare.Here, we report a case of primary vocal cord actinomycosismimicking a laryngeal tumor.

2. Case Report

Approximately one year ago, a 49-year-old Japanese mancame for treatment with the complaint of his hoarseness ofvoice for 2 years. He had no fever, odynophagia, weight loss,or dysphagia. There was no history of any operation in headand neck, and he had diabetes mellitus and dental caries.Laryngoscopy showed a mass of surface irregularity in theanterior one-third part of the left vocal cord (Figure 1). Therest of larynx and hypopharynx were normal. Examination of

the neck revealed no lymphadenopathy. Laboratory investi-gation including complete hemogram, erythrocyte sedimen-tation rate, renal function tests, and liver function tests waswithin normal limits.The value of HbA1c was 6.1. Serologicaltests for HIV, HbsAg, andHCVRNAwere negative. His chestroentgenogram was normal. The patient underwent directlaryngoscopy, and the mass was excised from the left vocalcord. In histopathological examination, the biopsy materialrevealed actinomycosis with vocal nodule (Figure 2). Aninfectious disease consultation was obtained, and the patientstarted treatment with amoxicillin-clavulanate 625mg orallythree times a day for 8 weeks. During the 2 months oftreatment, the vocal cords and other laryngeal structureswereobserved to be normal.

3. Discussion

Actinomycosis in human involves most commonly (60∼70%) the cervicofacial region and is most commonly due tothe Actinomyces israelii. Actinomyces israelii is a commensalsaprophyte of the normal oral flora [1–4]. Trauma, forexample, tooth extraction, caries, and dental manipulation,causes disruption of the normal mucosa and predisposes toinfection. Debilitating and immunosuppressing factors like

2 Case Reports in Otolaryngology

Figure 1: A mass of surface irregularity in the anterior one-thirdpart of the left vocal cord.

100 𝜇m100 𝜇𝜇𝜇𝜇𝜇𝜇𝜇𝜇𝜇m

Figure 2: Microscopically, specimen demonstrated vocal cordactinomycosis (hematoxylin and eosin).

diabetes, pregnancy, steroid therapy, or cancer are the otherpredisposing factors. Differentiating diagnosis includes car-cinoma, abscess, congenital anomalies, tuberculosis, fungaldiseases, and osteomyelitis. Because of its complex prepara-tion, actinomycosis may be termed “the masquerader of thehead and neck.”

Laryngeal actinomycosis is quite rare. A review of theliterature reveals that actinomycosis of the larynx is oftenassociated with an underlying history of squamous cellcarcinoma of the larynx and therapeutic radiation therapy[5]. An underlying history of systemic lupus erythematosus(SLE) and immunosuppression after renal transplantationhas also been reported [6]. Here, we report a case of laryngealactinomycosis without any the above mentioned underlyingdiseases. Laryngeal carcinoma and laryngeal papilloma arethe most commonly encountered tumorous lesions in thelarynx. Although actinomycosis arising from the vocal cordis extremely rare [7], we should consider this entity in thedifferential diagnosis of tumor and tumor-like lesions of thevocal cord.

The pathogenesis of laryngeal actinomycosis is not clear.Why the microorganism, which is normally present in themouth, should became pathogenic is poorly understood.Poor local hygiene, local tissue damage, diabetes mellitus,immune suppression, and malnutrition are suggested predis-posing factors [8]. Therefore, we postulate that in our patientdental caries and/or diabetes mellitus may cause disruptionof the normal mucosal barrier and lead to infection.

In summary, we describe an additional case of vocal cordactinomycosis in this paper.

Conflict of Interests

The authors declare that they have no conflict of interests.

Consent

A written consent was obtained from the patient for submis-sion of this paper.

References

[1] R. Langnickel, “Primary actinomycosis of the larynx,”Zeitschriftfur Laryngologie, Rhinologie, Otologie und ihre Grenzgebiete, vol.51, no. 3, pp. 147–152, 1972.

[2] J. L. Carpenter and M. S. Artenstein, “Use of diagnostic micro-biologic facilities in the diagnosis of head and neck infectionsInfectious diseases of the head and neck,” OtolaryngologicClinics of North America, vol. 9, no. 3, pp. 611–629, 1976.

[3] R. A. Hughes, D. F. Paonessa, andW. F. Conway, “Actinomycosisof the larynx,” Annals of Otology, Rhinology, and Laryngology,vol. 93, pp. 520–524, 1984.

[4] M. A. Syed, C. A. Ayshford, H. S. Uppal, and R. J. Cullen,“Actinomycosis of the post-cricoid space: an unusual cause ofdysphagia,” Journal of Laryngology and Otology, vol. 115, no. 5,pp. 428–429, 2001.

[5] A. Batur Calis, A. E. Ozbal, T. Basak, and S. Turgut, “Laryngealactinomycosis accompanying laryngeal carcinoma: report oftwo cases,” European Archives of Oto-Rhino-Laryngology, vol.263, no. 8, pp. 783–785, 2006.

[6] H. S. Sims and B. B. Heywood, “Post-transplant actinomy-cosis of the posterior glottis involving both vocal processes,”Otolaryngology—Head andNeck Surgery, vol. 137, no. 6, pp. 967–968, 2007.

[7] B. Khademi, S. H. Dastgheib-Hosseini, and M. J. Ashraf,“Vocal cord actinomycosis: a case report,” Iranian Journal ofOtorhinolaryngology, vol. 23, no. 2, pp. 49–52, 2011.

[8] I. Zajc, Z. Orihovac, andM. Bagatin, “Temporal actinomycosis:report of a case,” Journal of Oral and Maxillofacial Surgery, vol.57, no. 11, pp. 1370–1372, 1999.

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