Bilateral vocal cord paralysis in multifocal motor neuropathy

We present a case of a male in his fifties who attended with wheezing, dysphonia and shortness of breath. He was under investigation for asymmetrical muscle weakness in the absence of a sensory deficit for the preceding 1 year. Spirometry (flow volume loop) suggested extra-thoracic restriction and bronchoscopy confirmed bilateral vocal cord palsy. Due to clinical presentation and a positive anti-GM1, a diagnosis of multifocal motor neuropathy (MMN) with bilateral vocal cord palsy was made. The patient was initiated on intravenous immunoglobulin therapy with good effect on his general muscle weakness and respiratory symptoms, lung function and vocal cord abductor function. MMN with conduction block is a rare autoimmune condition, and vocal cord paresis from bilateral Xth cranial nerve involvement (recurrent laryngeal) is a very rare presentation of an MMN. Early diagnosis led to good patient outcomes.