The objective of this report is to emphasize the importance of differential diagnosis to distinguish infectious causes of chronic laryngitis. J.O.L, an 82-year-old married man, mulatto, born in Pernambuco, a resident of Duque de Caxias city, RJ and an ex-smoker, presented at the Otorhinolaryngology clinic MarcÃlio Dias Navy Hospital on October 14, 2011 with a 3-month history of dysphonia. Oropharyngoscopy was normal. He underwent video laryngoscopy, which revealed infiltration of the borders of the epiglottis and obliteration of the piriform sinuses along with severe retroarytenoid edema, increased supraglottic activity, and ventricular edema bands preventing visualization of the vocal folds. The patient developed sore throat and dysphagia. A biopsy of the suspicious lesions showed a chronic granulomatous inflammatory process with areas of ulceration strongly favoring a diagnosis of tuberculosis. A 6-moth treatment with rifampin, isoniazid, and pyrazinamide was initiated. . The patient still complained of dysphonia and laryngeal changes, and therefore, other possible diagnoses were considered, including paracoccidioidomycosis, which was confirmed by serologic tests. This case demonstrates the importance of differentiating the laryngeal form of paracoccidioidomycosis from laryngeal tuberculosis, histoplasmosis, and leishmaniasis. The definitive diagnosis is obtained by identifying the parasite in histopathology; however, this is not always possible, as demonstrated in the present case. Therefore, serology is also very important for diagnosis.
