We report a rare case of primary laryngeal actinomycosis, which occurred in a 35-year-old woman with end-stage renal failure secondary to systemic lupus erythematosus with membranous glomerulonephritis. The patient, who had been on long-term immunosuppression therapy, presented with hoarseness. Flexible laryngoscopy detected the presence of a granular glottic mass at the anterior commissure of the larynx. Histology revealed actinomycotic organisms associated with an abscess. The patient was treated with a prolonged course of oral penicillin V and speech therapy, and her dysphonia resolved almost completely. Although actinomycotic infection of the larynx is rare, it should be considered in the differential diagnosis of hoarseness in an immunocompromised patient.
Actinomycosis is a chronic, suppurative, granulomatous, and fibrosing infectious disease. It is characterized by an abscess-like formation surrounded by a granulomatous inflammatory reaction. In man, it is usually caused by Actinomyces israelii and less often by Arachnia (Actinomyces) propionica, Actinomyces naeslundii, Actinomyces viscosus, and Actinomyces odontolyticus. These anaerobic gram-positive bacteria are commensal organisms in the human oral cavity.1