Primary laryngeal aspergillosis due to Aspergillus flavus in an elderly immunocompetent patient- a rare presentation

Primary Laryngeal aspergillosis in an immunocompetent patient is rare and very few cases have been reported. Laryngeal aspergillosis due to secondary invasion from tracheobronchial tree is usually seen in an immunocompromised host. We report a case of a 65 year female who presented with 4 months history of breathlessness, hoarseness of voice and cough. She had ischaemic heart disease, hypertension, for which she was taking aspirin. She was known case of bronchial asthma on inhalational steroids. Video-laryngoscopy revealed greenish black debris in subglottic area, without any mucosal changes. Diagnosis of Aspergillus flavus was confirmed on culture. Ig E and absolute eosinophil count was within normal limits. Patient was started on oral itraconazole and has responded to treatment. Possibility of Primary fungal infection of larynx should be kept in mind, in elderly patients on inhalational steroids, without any known risk factors for immunocompromised states.