title: Bilateral vocal cord paralysis requiring tracheostomy due to neuroborreliosis.
abstract: Neuroborreliosis can cause multiple cranial and peripheral neuropathies; however, involvement of both recurrent laryngeal nerves is rare. We report the case of a 90-year-old man who presented with dysphonia and right upper and lower extremity weakness. His course was complicated by bilateral vocal cord paralysis and respiratory failure requiring tracheostomy. The diagnosis of borreliosis was made by detection of IgM and IgG antibodies against Borrelia burgdorferi on enzyme immunoassay and Western blot. The patient received IV ceftriaxone for 2 weeks, followed by complete recovery of motor and vocal function over 2 months. Our case is the third report of bilateral vocal cord paralysis in the literature, and the first one, to our knowledge, presenting with respiratory failure requiring an artificial airway. Physicians should be aware of this unusual complication of neuroborreliosis.
authors.affiliation: From the Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA. Electronic address: Carlos.Martinez-Balzano@umassmemorial.org.
authors.forename: Carlos D
authors.initials: CD
authors.lastname: Martínez-Balzano
authors.affiliation: From the Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA.
authors.forename: Bruce
authors.initials: B
authors.lastname: Greenberg
mesh_terms: D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D000907:Antibodies, Bacterial / Q000032:analysis*; D001898:Borrelia; D025065:Borrelia burgdorferi / Q000276:immunology*; D002443:Ceftriaxone / Q000008:administration & dosage; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D007828:Laryngoscopy; D020852:Lyme Neuroborreliosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008279:Magnetic Resonance Imaging; D008297:Male; D020127:Recovery of Function; D012131:Respiratory Insufficiency / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D014139:Tracheostomy / Q000379:methods*; D014826:Vocal Cord Paralysis / Q000150:complications* / Q000175:diagnosis / Q000628:therapy
chemical_list: D000900:Anti-Bacterial Agents; D000907:Antibodies, Bacterial; D002443:Ceftriaxone