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Drug-Induced Paradoxical Vocal Fold Motion
Marlene Garcia-Neuer1, Donna Marie Lynch1, Kathleen Marquis2
1Division of Rheumatology, Allergy and Immunology, Brigham and Women's Hospital, Boston, Mass.
The Journal of Allergy and Clinical Immunology. in Practice
|October 18, 2017
Summary
Paradoxical vocal fold motion (PVFM) mimics asthma symptoms and is often misdiagnosed. This case highlights PVFM underreporting in hypersensitivity reactions, emphasizing accurate diagnosis for effective patient management.
Area of Science:
- Pulmonology
- Allergy and Immunology
- Otolaryngology
Background:
- Vocal cord dysfunction (VCD), or paradoxical vocal fold motion (PVFM), presents with inspiratory stridor, mimicking asthma.
- PVFM is frequently misdiagnosed due to overlapping symptoms like wheezing, cough, and dyspnea.
Observation:
- A 36-year-old woman with juvenile rheumatoid arthritis experienced recurrent episodes misdiagnosed as anaphylaxis during drug allergy testing and desensitization.
- These episodes, involving skin testing, omalizumab, and tocilizumab, were treated with epinephrine before PVFM diagnosis.
Findings:
- Diagnosis of PVFM led to the cessation of recurrent respiratory events.
- The patient successfully continued drug allergy treatment after PVFM diagnosis and management.
Implications:
- PVFM may be underdiagnosed in patients with hypersensitivity reactions due to similar respiratory symptoms.
- Distinguishing PVFM from Type 1 hypersensitivity reactions is crucial for appropriate treatment and avoiding unnecessary interventions.