Postcricoid pharyngeal carcinoma mimicking bulbar amyotrophic lateral sclerosis

Bulbar weakness, including dysarthria, dysphagia, or progressive respiratory weakness, occurs as the presenting feature in approximately 25% of patients with amyotrophic lateral sclerosis (ALS). Misdiagnosis of ALS in patients with progressive bulbar symptoms is uncommon. This report describes a 73-year-old man who had a 10-month history of progressive hoarseness, dysphagia, and respiratory failure. The initial diagnosis was bulbar ALS. Computed tomography of his neck identified a postcricoid squamous cell carcinoma, which was causing bilateral vocal cord paralysis. To the author's knowledge, postcricoid carcinoma has not been previously described as mimicking ALS but should be considered in the differential diagnosis of bulbar ALS.