每日一题_2023.07.13

A 78-year-old man with chronic obstructive pulmonary disease (COPD) presented with a 2-month history of dysphonia. For the past 10 years, he had used an inhaled glucocorticoid daily to manage his COPD. Fiberoptic laryngoscopy revealed white plaques on both vocal cords. A biopsy showed hyperkeratinized stratified squamous epithelium and threadlike filaments that stained with Grocott-Gomori methenamine silver stain. What is the most likely diagnosis?

患者男，78岁，慢性阻塞性肺疾病(COPD)，因嗓音障碍2个月就诊。在过去10年里，他每天使用吸入型糖皮质激素治疗COPD。纤维喉镜检查发现双侧声带有白色斑块。病理检查可见过度角化的复层鳞状上皮和丝状细丝，grocot – gomori六胺银染色。最有可能的诊断是什么?

A. Laryngeal amyloidosis 喉淀粉样变

B. Laryngeal candidiasis 喉念珠菌病

C. Laryngeal papillomatosis 喉乳头瘤病

D. Leukoplakia 黏膜白斑病

E. Vocal-cord dysfunction 声带功能障碍

答案解析：

在grocot – gomori六胺银染色阳性的丝状细丝表明真菌存在。诊断为喉念珠菌病。患者接受了一个疗程的氟康唑治疗。在2周的随访中，他的声音已恢复正常，喉镜检查结果也有所改善。

正确答案：B