A Novel Case of Paraglottic Burkholderia Cepacia Complex Infection Mimicking a Laryngeal Malignancy

The Burkholderia cepacia complex (BCC) is a rare pathogen typically causing respiratory illnesses in immunocompromised individuals. We present a novel case of BCC manifesting as a laryngeal abscess, mimicking a laryngeal malignancy in an immunocompetent patient. A 74-year-old male presented to the emergency department with acute respiratory failure and was emergently intubated, revealing abnormal supraglottic tissue. ENT consultation post-extubation and flexible laryngoscopy suggested malignancy in the right supraglottis. A subsequent CT neck showed an expansive paraglottic mass, again consistent with an advanced malignancy. During direct laryngoscopy with biopsy, purulence was encountered, and cultures were obtained. Biopsy results showed benign mucosa with inflammation, and cultures identified BCC. The patient received 7 days of Levofloxacin and Ampicillin-Sulbactam before culture results. Follow-up 2 weeks later showed near-complete symptom resolution, normal supraglottic mucosa on flexible laryngoscopy, and interval CT neck showed resolution of the "mass." This case involves an unusual presentation of an acute paraglottic BCC infection initially mistaken for a laryngeal mass. BCC is typically a threat to individuals with cystic fibrosis (CF) or other immunocompromised states due to its intrinsic antibiotic resistance. However, BCC is rarely implicated in paraglottic infections or abscess formation. This is the first reported case of a laryngeal BCC infection mimicking a laryngeal mass. It underscores the importance of maintaining an open differential diagnosis until pathologic confirmation, even when imaging and clinical examination suggest malignancy. Laryngoscope, 2024.