title: Recurrent laryngeal nerve paralysis due to subclinical Lyme borreliosis.
abstract: OBJECTIVE
  We report an extremely rare case of recurrent laryngeal nerve paralysis due to subclinical Lyme borreliosis.
  
  
  METHODS
  Case report presenting a 15-year-old girl referred with hoarseness and soft voice.
  
  
  RESULTS
  Right-sided recurrent laryngeal nerve paralysis was observed using videolaryngoscopy. Imaging was used to exclude intracranial, cervical and intrathoracic embryological lesions, vascular malformations and tumours. Laboratory and electrophysiological investigations were used to exclude inflammatory and paraneoplastic processes, endocrinopathy and metabolic disorders. Serological testing was positive for Lyme disease. Parenteral ceftriaxone therapy was commenced. The patient's nerve paralysis showed complete recovery on the seventh day of antibiotic treatment; this was confirmed by videolaryngoscopy.
  
  
  CONCLUSIONS
  Recurrent laryngeal nerve paralysis is an extremely rare complication of neuroborreliosis associated with Lyme disease. In patients with recurrent laryngeal nerve paralysis in whom the clinical history is uncertain and the usual diagnostic methods give negative results, screening with anti-borrelia immunoglobulin M is suggested.
authors.affiliation: Department of Otolaryngology Head and Neck Surgery, University Medical School of Debrecen, Debrecen, Hungary. karositamas@gmail.com
authors.forename: T
authors.initials: T
authors.lastname: Karosi
authors.forename: T
authors.initials: T
authors.lastname: Rácz
authors.forename: E
authors.initials: E
authors.lastname: Szekanecz
authors.forename: A
authors.initials: A
authors.lastname: Tóth
authors.forename: I
authors.initials: I
authors.lastname: Sziklai
mesh_terms: D000293:Adolescent; D000328:Adult; D025065:Borrelia burgdorferi / Q000276:immunology; D005260:Female; D006685:Hoarseness / Q000209:etiology; D006801:Humans; D008193:Lyme Disease / Q000150:complications*; D012009:Recurrent Laryngeal Nerve; D014826:Vocal Cord Paralysis / Q000209:etiology*