Histoplasmosis usually occurs in immunocompromised patients through the dissemination of the fungus from lungs to other organs but laryngeal involvement is rare. We report a 52-year-old male chronic smoker who presented with hoarseness for 3 months was initially investigated for laryngeal carcinoma. However biopsy showed granulomatous inflammation. He was treated with anti-tuberculosis treatment for 2 months but symptoms persisted and a repeat biopsy revealed laryngeal histoplasmosis. There were no sign and symptoms of pulmonary or systemic involvement. Treatment with intravenous amphotericin B and oral itraconazole lead to complete resolution of symptoms and signs. Monitoring and early revisiting the diagnosis are important when a patient’s symptoms do not improve with the treatment. Further investigation including a repeat biopsy of lesion is vital to establish the diagnosis and lead to appropriate management.