Abstract
This 59-year-old male was initially treated by a general practioner under a diagnosis of acute laryngitis because the patient developed hoarseness after an upper respiratory infection.
In about one month, the patient was seen by an otolaryngologist who found the cause of his hoarseness was left recurrent nerve paralysis which was considered to be due to viral infection and was treated conservatively for about three months without improvement.
The patient visited the authors' hospital three and a half months after the onset of the disease. He was then found to have tuberculous lesions in the upper lobes of both lungs.
Culture of his sputum showed a positive result for tuberculous bacilli.
The tuberculous lesion was taken into consideration as a possible cause of his recurrent paralysis. Meanwhile, the patient developed severe pain in the chest, which was found to be due to deformans of the cervical spine. Traction of the cervical spine relieved the symptom rapidly.
A few months later the patient developed fracture of the left iliac bone, for which canvas traction was used. The patient developed dyspnea one night lasting for about 30 minutes, which was later found to have been caused by bilateral vocal cord paralysis.
The patient died due to cardiac arrest two days after a tracheostomy was perfomed.
The autopsy revealed concurrent adenocarcinoma of the left lung.
It was difficult to identity the true cause of the vocal cord paralysis because the lung tumor was concealed by the pulmonary tuberculous lesion and the patient did not show any significant symptoms suggesting the lung cancer.
