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Vincristine-induced vocal cord paralysis in an infant
Doralina L Anghelescu1, Alberto J De Armendi, Jerome W Thompson
1Division of Anesthesia, St Jude Children's Research Hospital, Memphis, TN 38105-2794, USA. doralina.anghelescu@stjude.org
Insights
Vincristine, a chemotherapy drug, can cause rare but serious vocal cord paralysis in infants with acute lymphoblastic leukemia. Prompt airway evaluation is crucial for infants experiencing stridor while on vincristine treatment.
Area of Science:
- Pediatric Oncology
- Neuro-oncology
- Clinical Toxicology
Background:
- Acute lymphoblastic leukemia (ALL) is a common childhood cancer.
- Vincristine is a standard chemotherapeutic agent used in ALL induction therapy.
- Neurological complications of vincristine are known but rare.
Observation:
- A 5-month-old infant with ALL developed stridor and dysphagia after vincristine administration.
- Direct laryngoscopy revealed bilateral vocal cord paralysis, necessitating intubation.
- Vocal cord mobility recovered within 7 days, allowing for extubation.
Findings:
- The infant's symptoms were attributed to vincristine-induced bilateral recurrent laryngeal nerve paralysis.
- This represents a rare, potentially life-threatening adverse effect of vincristine therapy.
- Recurrent laryngeal nerve paralysis can lead to significant upper airway compromise.
Implications:
- Clinicians should suspect vincristine-induced vocal cord paralysis in infants with stridor during chemotherapy.
- Airway visualization is essential for diagnosing upper airway obstruction in this patient population.
- Early recognition and management are critical for preventing severe respiratory complications.
Abstract:
We report the development of stridor and dysphagia in a 5-month-old-infant with acute lymphoblastic leukaemia after the administration of four weekly doses of vincristine during induction therapy. Because direct laryngoscopy revealed bilateral vocal cord paralysis, the patient underwent elective intubation. Extubation was performed 7 days later, after direct laryngoscopy confirmed recovery of vocal cord mobility. Vincristine-induced bilateral recurrent laryngeal nerve paralysis is a rare but potentially life-threatening complication. Therefore, it should be suspected when stridor is present, and clinicians should consider visualization of the airway to establish the cause of upper airway compromise in infants receiving vincristine.