Laryngeal Mucormycosis—A Rare Differential Diagnosis for Airway Obstruction in Immunocompromised Patient: A Case Report

REPORTsubglottic region and sent for histopathological examination.Report showed granulation tissue with mixed inflammatory infiltrate, necrosis, along with broad aseptate branching fungal hyphae favoring mucormycosis (Fig. 2).No evidence of dysplasia/malignancy was noted.Infectious disease specialist opinion was taken and patient was started on 1 tablet posaconazole 300 mg twice daily on first day, followed by once daily orally.After 2 months of antifungal treatment, direct laryngoscopy under general anesthesia (GA) was performed, which revealed edematous bilateral vocal cords.There was unhealthy granular mucosa over the posterior glottis and significant subglottic narrowing due to chondromatous dead tissue and necrotic granulations (Fig. 3). IntroductIonMucormycosis (Zygomycosis) is an opportunistic fungal infection that primarily affects diabetic and immunocompromised patients.Recently, this infection had become increasingly prevalent after the COVID-19 pandemic due to immunosuppressive medication and rising incidence of diabetes mellitus.According to WHO, incidence rate of mucormycosis globally varies from 0.005 to 1.7 per million population.In India, prevalence of mucormycosis is estimated as 140 per million population.Pathophysiology of mucormycosis involves angioinvasion and tissue destruction; this process is mediated by a number of fungal proteases, lipases, and mycotoxins.Presenting complaints based on the site involved; most commonly it affects sinus, orbit, skin, and lungs.Laryngeal involvement is very rarely seen in this infection and very limited literature is available.We report a case of laryngeal mucormycosis that was managed by combined modality treatment and a multidisciplinary approach involving antifungal therapy and complex laryngeal framework surgery. case descrIptIonA 52-year-old male patient with type 2 diabetes mellitus visited nearby hospital with difficulty in breathing and throat pain for the past 10 days.Examination revealed severe stridor due to significant upper airway narrowing; hence, emergency tracheostomy was performed.After the patient was stabilized, he was shifted to our hospital for definitive management.Flexible laryngoscopy was performed under local anesthesia, which showed a large transglottic growth involving the subglottic region and edema over epiglottis.Bilateral vocal cords were mobile.On fibreoptic endoscopic evaluation of swallowing, no aspiration was noted (Fig. 1).After routine blood investigations, the patient underwent direct laryngoscopy and biopsy.Multiple punch biopsies were taken from 1-3,