Spontaneous Laryngeal Abscess: A Diagnostic Conundrum Mimicking Malignancy Resolved With Conservative Treatment

Laryngeal abscesses (LA), though rare in the modern antibiotic era, remain potentially life-threatening, especially when associated with airway obstruction. This case report presents a 55-year-old immunocompetent female, a heavy smoker and alcohol user, who developed a spontaneous supraglottic laryngeal abscess masquerading as a malignant pathology. The patient presented with odynophagia, dysphagia, and dysphonia, along with inspiratory stridor. Fiberoptic endoscopy revealed a mass in the left aryepiglottic fold and ipsilateral vocal fold immobility. Imaging studies demonstrated a supraglottic formation with necrotic features and bilateral cervical lymphadenopathy. After 3 days of intravenous antibiotics and corticosteroids, the patient's symptoms improved, and she was discharged on oral antibiotics. At 14 days, endoscopy confirmed the resolution of the aryepiglottic fold swelling and normal vocal fold mobility. The clinical evolution, including the patient's response to conservative treatment coupled with the laryngeal status at follow-up, ultimately confirmed the diagnosis of a laryngeal abscess rather than a malignancy. The case underscores the importance of considering laryngeal abscess in the differential diagnosis for patients presenting with persistent symptoms and highlights the need for thorough diagnostic evaluation, including imaging and biopsy when malignancy is suspected. Furthermore, it emphasizes the potential effectiveness of conservative treatment with antibiotics, particularly when airway management and timely intervention are prioritized, thus reducing the need for invasive surgical procedures.