Left Recurrent Laryngeal Nerve Vocal Fold Paralysis in Pediatric Patient Secondary to Mediastinal Histoplasmosis Infection

Histoplasma capsulatum is a dimorphic soil-based fungus endemic to the Ohio and Mississippi River valleys and southeastern United States. An extremely rare presentation is the involvement of the mediastinum leading to vocal fold paralysis, with only 2 reported cases in the literature. This report presents the youngest patient to whom this pathology has been described and the third overall patient. In this case report, we present a 15-year-old boy with vocal fold paralysis secondary to left recurrent laryngeal nerve paralysis in the setting of confirmed histoplasmosis infection. On further workup, he was noted to have mediastinum lymphadenopathy on computed tomography (CT) chest. Pathology of the biopsy indicated granulomatous inflammation without the evidence of malignancy, prompting fungal serology testing resulting in a positive histoplasma antibody result. The patient received appropriate treatment, yet the dysphonia persisted. On flexible laryngoscopy, he was noted to have left vocal fold paralysis. After 2 years of ongoing paralysis, the decision was made to proceed with recurrent laryngeal nerve innervation for long-term benefits. After nerve innervation and fat laryngoplasty, the patient has had significant improvement in dysphonia and voice parameters.