Sarcoidosis Presenting as Bilateral Vocal Cord Paralysis due to Bilateral Vagal Nerve Involvement

Abstract

We herein report a rare case of sarcoidosis presenting as bilateral vocal cord paralysis due to bilateral vagal nerve involvement. A 72-year-old woman with uveitis of the left eye complained of hoarseness and aspiration due to bilateral vocal cord paralysis. An endobronchial needle aspiration biopsy specimen of the mediastinal lymph nodes showed non-caseating epithelioid cell granuloma. Total protein and cell concentrations in the cerebrospinal fluid were increased. We diagnosed her to have sarcoidosis with bilateral vagal nerve involvement. Corticosteroid therapy improved her symptoms of hoarseness and aspiration. Sarcoidosis should therefore be taken into consideration as a potential cause of bilateral vocal cord paralysis.

Neurosarcoidosis Directly Involving the Cervical Vagus Nerve

“…Sarcoidosis has previously been proposed to cause vocal cord immobility by three possible mechanisms: (1) Compressive mediastinal lymphadenopathy, (2) direct laryngeal involvement, (3) cranial polyneuritis. 7,10 The present case is the first to demonstrate cranial polyneuritis that is biopsy-proven to be sarcoidomatous involvement of the cervical portion of the vagus nerve. These findings likely translate to other areas of mass-like lesions observed in the lower cranial nerves in this patient.…”

“…6 As opposed to external compression, bilateral vocal cord paralysis has been theorized to be due to cranial neuritis from neurosarcoidosis, however this has not been confirmed histologically. 7,8 Distinguishing between neurosarcoidosis and other cerebellopontine angle and carotid sheath tumors is challenging, but important because treatment is different. The present case is the first to our knowledge reported of bilateral vocal cord paralysis due to bilateral skull base granulomatous inflammation and histologicallyconfirmed direct involvement of the vagus nerve by granulomatous inflammation.…”

Recurrent Laryngeal Nerve Palsy in Sarcoidosis Diagnosis and Management

“…A normal EMG will be a strong suggestion for direct infiltration of the larynx rather than neural involvement [23]. The serum angiotension-converting enzyme (ACE) levels not been utilized as it lacks the sufficient specificity as a diagenetic tool [24][25][26][27][28][29][30][31][32][33][34][35][36].…”

Sarcoidosis presenting as vocal cord palsy: an unusual presentation and literature review

“…Among the potential laryngeal manifestations, supraglottic and subglottic involvement is usually implicated, with disease rarely affecting the true vocal cords [2]. Literature has shown three mechanisms involved with the development of VCP in sarcoidosis [3][4][5][6][7]. The first mechanism involves direct invasion of vocal cords by granulomatous tissue.…”