ENT, Lister Hospital, Stevenage, UK
Neurology, Lister Hospital, Stevenage, UK.
BMJ Case Rep. 2021 Jan 12;14(1):e234070. doi: 10.1136/bcr-2019-234070.
A previously fit and well 53-year-old man was referred to the otolaryngology clinic with intermittent stridor and was found to have bilateral vocal fold paresis. Subsequent airway compromise necessitated emergency surgical tracheostomy. The man was discharged home with tracheostomy in situ and a diagnosis of idiopathic bilateral vocal cord palsy, as all primary investigations were negative. Neurological disease was suspected following readmission to hospital several weeks later with diplopia. Electromyography and serum antibody testing confirmed a diagnosis of anti-muscle-specific tyrosine kinase antibody positive myasthenia gravis (MuSK-MG); a subset of MG where autoantibodies are directed against MuSK. Resolution of bilateral vocal fold paresis was found 8 months after a short course of immunoglobulin (intravenous immunoglobulin (IVIg)) and daily mycophenolate therapy was commenced. Multidisciplinary teamwork between ear, nose and throat surgeons, neurologists and speech therapists enabled successful decannulation of tracheostomy. The patient has recovered well and remains minimally symptomatic.
一位先前身体健康的 53 岁男性因间歇性喘鸣到耳鼻喉科就诊，发现双侧声带麻痹。随后出现气道阻塞，需要紧急行气管切开术。该男性出院时带有气管造口管，诊断为特发性双侧声带麻痹，因为所有的初步检查均为阴性。数周后因复视再次入院，怀疑患有神经疾病。肌电图和血清抗体检测证实诊断为抗肌肉特异性酪氨酸激酶抗体阳性重症肌无力（MuSK-MG）；这是一种自身抗体针对 MuSK 的重症肌无力亚组。在接受短期免疫球蛋白（静脉注射免疫球蛋白（IVIg））治疗和开始每日霉酚酸酯治疗 8 个月后，双侧声带麻痹得到缓解。耳鼻喉科外科医生、神经科医生和言语治疗师之间的多学科团队合作成功地进行了气管造口管拔管。该患者恢复良好，症状基本消失。
