A rare manifestation of a multisystemic disease: a case of vocal cord palsy secondary to sarcoidosis

Abstract

We describe a rare case of recurrent laryngeal nerve neuritis secondary to sarcoidosis. A 40-year-old woman presented with persistent dysphonia. This was her first episode of dysphonia with no reports of laryngeal trauma. Fibre-optic laryngoscopy revealed a normal nasal passage, nasopharynx and pharynx. The supraglottic structures were all unremarkable; however, inspection of the true vocal cords revealed a left vocal cord palsy that was identified as being in a paramedian position. Radiological investigation showed mediastinal adenopathy that measured up to 20 mm in the short axis diameter. Histological examination showed granulomatous lymphadenitis of the lymph node with a central area of sclerosis surrounded by discrete, non-caseating granuloma. Stains for acid-fast bacilli were negative. The morphological features were suggestive of sarcoidosis. The lymphadenopathy distribution and size did not suggest left recurrent laryngeal nerve compression, giving a subsequent diagnosis of recurrent laryngeal nerve neuritis secondary to sarcoidosis.

Figure 1

CT scan showing precarinal lymphadenopathy—in keeping with sarcoidosis. The arrow points to the aortopulmonary bay lymph nodes.

Figure 2

CT scan showing the absence of significant large lymphadenopathy underneath the aortic arch—the route taken of the left recurrent laryngeal nerve. The arrow points to the aortopulmonary bay lymph nodes.