From the Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA.
From the Division of Pulmonary, Allergy, and Critical Care Medicine, Department of Medicine, University of Massachusetts Medical School, Worcester, MA.
Chest. 2014 Nov;146(5):e153-e155. doi: 10.1378/chest.14-0515.
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.
神经莱姆病可引起多种颅神经和周围神经病；然而，同时累及双侧喉返神经则较为罕见。我们报告了一例 90 岁男性患者，以声音嘶哑和右上肢及下肢无力为主要表现。其病程复杂，出现双侧声带麻痹和呼吸衰竭，需要行气管切开术。通过酶联免疫吸附试验和免疫印迹法检测到针对伯氏疏螺旋体的 IgM 和 IgG 抗体，诊断为莱姆病。患者接受了 2 周的静脉头孢曲松治疗，2 个月后运动和发声功能完全恢复。我们的病例是文献中第 3 例双侧声带麻痹的报道，据我们所知，也是首例出现呼吸衰竭需要人工气道的病例。医生应该意识到神经莱姆病的这种不常见并发症。
