Ab1804

Primary aspergillosis of the larynx in a patient with Felty's syndrome

S. Morelli, A. Sgreccia, M.L. Bernardo, C. Della Rocca¹, A. Gallo², G. Valesini

Istituto di Clinica Medica I, Istituto di Anatomia Patologica¹, and Istituto di Otorinolaringoiatria², Università “La Sapienza”, Rome, Italy.

ABSTRACT
Herein we report the first case of primary aspergillosis of the larynx in a patient with Felty's syndrome. A 53-year-old man, a florist by profession, with a 12-year history of rheumatoid arthritis and on treatment with steroids, was admitted because of hoarseness, and intermittent fever of 2 weeks' duration. On admission, physical examination and laboratory data showed, among other findings, splenomegalia and neutropenia. At bone marrow examination, normal cellularity with mild dyserythropoiesis was observed. A fiberoptic laryngoscopy showed white plaques on both the true vocal cords. Both culture and microscopic examination of these lesions provided the diagnosis of invasive process by Aspergillus flavus. A computed tomography of the middle ears, paranasal sinuses, and chest was normal. Thus, primary aspergillosis of the larynx and Felty's syndrome was diagnosed, and the patient was successfully treated with granulocyte colony-stimulating factor and systemic antifungal agents.
Felty's syndrome, corticosteroid use, and occupational risk probably rendered our patient susceptible to Aspergillus infection.

Key words
Aspergillosis, Felty's syndrome, rheumatoid arthritis.

Please address correspondence and reprint requests to: Sergio Morelli, MD, Istituto di Clinica Medica I, Università “La Sapienza”, Policlinico Umberto I, Viale del Policlinico, 00161 Rome, Italy.
E-mail: smorelli@uniroma1.it