Vincristine-induced vocal cord palsy and successful re-treatment in a patient with diffuse large B cell Lymphoma: a case report

Abstract

BackgroundVincristine, a type of vinca alkaloid, is widely used in the treatment of various childhood and adult malignancies. A well-known side effect of vincristine is its neurotoxicity and it is rarely indicted in vagus nerve involvement. Vincristine induced vocal cord palsy is a potentially reversible condition, with the mainstay of therapy being withdrawal of the offending drug. However, there are no clear guidelines regarding the possibility of re-treatment with the causative agent.Case presentationA 58 year old Asian male presented with constipation and abdominal distension. Diagnostic investigations revealed stage IVB diffuse large B cell lymphoma (DLBCL). The patient was subsequently started on R-CHOP (Rituximab, Cyclophosphamide, Doxorubicin, Vincristine, and Prednisolone). On day twelve of receiving course four of R-CHOP, our patient presented to the hospital with a history of hoarseness of voice. Clinical and radiological examination revealed bilateral vocal cord palsy. Tracheostomy was done in view of a compromised airway. The patient subsequently went on to receive two more cycles of R-CHOP. Two weeks later Flexible laryngoscopy showed no lesion and the vocal cords were moving normally. The tracheostomy was removed. His voice has improved since and the patient is currently in remission.ConclusionThe occurrence of vincristine induced vocal cord palsy has been well reported in the literature. We strongly believe that our patient developed vocal cord palsy secondary to vincristine. The uniqueness of our patient’s case lies in successful re-treatment of our patient with the offending drug. To the best of our knowledge this is the third instance where a patient was successfully re-treated with vincristine after having developed vocal cord palsy as a result of its use.

Vincristine-Induced Bilateral Vocal Cord Palsy in an Adult Male With Diffuse Large B-Cell Lymphoma

“…Involvement of the cranial nerves is less common. BLVCP is infrequently described in the literature, with fewer than 20 cases reported [3][4][5][6]. Of these, the majority occurred in pediatric patients.…”

“…Recovery time to normal vocal cord mobility is reported to range from two weeks to nine months (most commonly three to six months). One series reported re-treatment with a lower dose of vincristine at a later date [ 6 ].…”

An unusual cause of difficult weaning in a patient with newly diagnosed small cell lung cancer

“…We found one case report of a bilateral vocal cord paralysis caused by Platinum chemotherapy, this resolved after the chemotherapy was stopped [7] . Vincristine can also cause a reversible (bilateral)laryngeal nerve paresis even with the possibility to retreat the patient with the same chemotherapeutic drug [8] .…”

Vocal Fold Motion Impairment Following Chemotherapy Administration: Case Reports and Review of the Literature

“…CIVFMI secondary to vinblastine (n = 2, 5.7%), paclitaxel (n = 2, 5.7%) and cisplatin (n = 1, 2.9%) has also been reported. It is important to note that many chemotherapeutic agents were not used as monotherapy but rather as part of an established multiagent protocol, such as the RCHOP protocol for ALL consisting of vincristine, rituximab, cyclophosphamide, Harris et al 13 Moderate Naithani et al 14 High Praveen et al 15 High Taha et al 16 Moderate Kumar et al 17 High Rezvani et al 18 Moderate Whittaker et al 19 High Choi et al 20 High Aghajan et al 21 Moderate Rahmat et al 22 High Kuruvilla et al 11 Moderate Aaron et al 23 High Patra et al 24 High Ahmed et al 25 High Samoon et al 26 High Latiff et al 27 High Bacon et al 28 High Anghelescu et al 29 Moderate Zavala et al 30 High Yalin et al 31 High Burns et al 32 Moderate Farruggia et al 33 High Cherif et al 34 High Total 25 0 25 0 25 0 16 9 25 0…”