(A721) Laryngeal Cryptococcosis in the Setting of Dupilumab Treatment: A Case Report

Introduction: Dupilumab is a monoclonal antibody targeting IL-4 and IL-13 and often used to treat severe asthma and other atopic conditions. We describe the development and successful treatment of laryngeal cryptococcosis in a patient on Dupilumab for severe asthma.

Methods: Case report from a tertiary care center.

Results: A 63-year-old male with a past medical history of asthma on Dupilumab and inhaled corticosteroids was seen at our tertiary care center for persistent dysphonia, chronic cough, and throat clearing. An outside otolaryngologist had previously diagnosed candida laryngitis and treated him with fluconazole. On exam, he had erythema and irregularity of the bilateral true vocal folds and purulent debris of the bilateral true vocal folds. At that time, he was treated with a 14-day course of Bactrim for possible bacterial laryngitis. After symptoms persisted, a direct microlaryngoscopy and biopsy in the operating room was performed, with dermatopathology displaying evidence of Cryptococcus colonization. After ruling out disseminated infection, our patient was successfully treated with liposomal amphotericin B and a prolonged course of fluconazole. At two months post-treatment, his symptoms had resolved and there was objective resolution of exam findings.

Conclusions: Our case represents an exceedingly unique situation in which an already rare disease presentation is coupled with a background of immunomodulation with Dupilimab. While prior studies have reported rare cryptococcal infections in patients on inhaled corticosteroids, the role of Dupilumab in cryptococcal infections has not been explored. Further research is warranted to explore the relationship between dupilumab and susceptibility to fungal infections.