Although varicella zoster virus (VZV) reactivation is well known to cause Ramsay Hunt syndrome, characterized by facial nerve paralysis and vestibulocochlear nerve disorder, it can also cause other cranial nerve disorders. Disorders of the vagus nerve are particularly common, and are usually unilateral, although there are also rare case reports of bilateral involvement. Herein, we report a case of bilateral vocal cord paralysis caused by VZV reactivation, along with a review of the relevant literature.
The patient was an 83-year-old woman who visited our department with the chief complaints of headache, pharyngodynia, and respiratory discomfort. Endoscopic examination of the laryngopharynx revealed redness, swelling, and mucosal eruptions in the left epiglottis and left arytenoid, in addition to saliva accumulation in the left pyriform sinus and bilateral vocal cord paralysis. Hematological examination revealed increased serum titers of VZV IgG and VZV IgM, and a cerebrospinal fluid examination revealed increased cell counts. Based on the findings, the patient was diagnosed as having with bilateral vocal cord paralysis and meningitis associated with VZV reactivation, and treatment was initiated with antiviral drugs and intravenous steroids. The patient was discharged from the hospital with improvement of the symptoms, on day 50 of the illness. The bilateral vocal cord paralysis resolved nearly completely within approximately three months of discharge.
Even in cases presenting with bilateral vocal cord paralysis, VZV reactivation should be suspected as a possible cause, and early therapeutic intervention may be necessary, especially in patients presenting with pharyngodynia and mucosal eruption.
