Letter to the Editor
Vocal cord palsy as a clinical manifestation of Behçet's disease
Parálisis de cuerda vocal como manifestación clínica de enfermedad de Behçet
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On the right side, an axial slice showing the same position of the vocal cord (arrow), findings compatible with paralysis.</p>" ] ] ] "textoCompleto" => "<span class="elsevierStyleSections"><p id="par0005" class="elsevierStylePara elsevierViewall">Behçet's disease (BD) is a rare autoimmune disease, with distinctive features like recurrent oral ulcers and, in most cases, genital ulcers. The symptoms can also include ophthalmological, neurological, dermatological, vascular, musculoskeletal, intestinal and pulmonary manifestations.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a> Involvement of the larynx is not common. We report the case of an individual with BD that affected a vocal cord.</p><p id="par0010" class="elsevierStylePara elsevierViewall">The patient was a 58-year-old man who had stopped smoking 3 years earlier and had no other medical history of interest. He came to the department of internal medicine with recurrent oral and genital ulcers that had developed 2 months earlier. They were accompanied by fever and he felt generally unwell. Moreover, he also had a 2-week history of dysphonia, with no other associated symptoms.</p><p id="par0015" class="elsevierStylePara elsevierViewall">Physical examination revealed dysphonia and the presence of painful scrotal and oral ulcers. In addition, he had an acneiform eruption on his back and lesions compatible with erythema nodosum on lower limbs. He presented no other problems.</p><p id="par0020" class="elsevierStylePara elsevierViewall">Laboratory analyses disclosed leukocytosis, neutrophilia and an elevation of acute-phase reactants: 14,000<span class="elsevierStyleHsp" style=""></span>leukocytes/mm<span class="elsevierStyleSup">3</span> (78% neutrophils) and a C-reactive protein level of 150<span class="elsevierStyleHsp" style=""></span>mg/L.</p><p id="par0025" class="elsevierStylePara elsevierViewall">Cranial computed tomography (CT) showed no evidence of ischemic or hemorrhagic cerebral vascular involvement. Cervicothoracic CT (<a class="elsevierStyleCrossRef" href="#fig0005">Fig. 1</a>) revealed paralysis of left vocal cord, whereas abdominal CT disclosed infrarenal abdominal aortic aneurysm measuring 47<span class="elsevierStyleHsp" style=""></span>mm<span class="elsevierStyleHsp" style=""></span>×<span class="elsevierStyleHsp" style=""></span>48<span class="elsevierStyleHsp" style=""></span>mm, with no other findings.</p><elsevierMultimedia ident="fig0005"></elsevierMultimedia><p id="par0030" class="elsevierStylePara elsevierViewall">The study of ear, nose and throat confirmed paralysis of left vocal cord. There was no ophthalmological involvement. Tests for autoimmunity included antinuclear antibodies, antineutrophil cytoplasmic antibodies, antiphospholipid antibodies, rheumatoid factor and anti-cyclic citrullinated peptide antibodies, all negative. Serological tests ruled out bacterial infectious diseases like syphilis, Lyme disease and chlamydiosis and polymerase chain reaction for herpesvirus 1 and 2 and cytomegalovirus was negative. Blood cultures were also negative.</p><p id="par0035" class="elsevierStylePara elsevierViewall">The patient underwent a pathergy test in right arm, which was positive, and a punch biopsy of the skin in the region of the acneiform eruption on his back showed evidence only of pseudofolliculitis. Given the clinical suspicion of BD, treatment was begun with oral glucocorticoids at a dose of 20<span class="elsevierStyleHsp" style=""></span>mg a day. The treatment with corticosteroids improved the ulcers and skin lesions, but there was no change in the dysphonia. The aneurysm observed in CT images subsequently required surgical treatment, which was successful.</p><p id="par0040" class="elsevierStylePara elsevierViewall">Behçet's disease is an immune-mediated systemic vasculitis, characterized by the presence of recurrent orogenital ulcers, ocular inflammation and skin lesions. The etiology and pathogenesis of BD are unknown, although it has been demonstrated that the presence of human leukocyte antigen (HLA) B51 constitutes an important genetic predisposing factor, especially among patients from the Middle and Far East.<a class="elsevierStyleCrossRef" href="#bib0030"><span class="elsevierStyleSup">1</span></a></p><p id="par0045" class="elsevierStylePara elsevierViewall">Being a multisystemic vasculitis, almost any part of the organism can be affected. The oral ulcers, recurrent and painful, are present in 90%–100% of the patients with BD. Other frequent clinical manifestations are genital ulcers (60%–80%), ocular lesions (67%–95%), skin lesions (41%–94%), arthritis (47%–69%) and neurological involvement (8%–31%).<a class="elsevierStyleCrossRef" href="#bib0035"><span class="elsevierStyleSup">2</span></a> The cutaneous manifestations of the patient we describe was nearly diagnostic of BD.</p><p id="par0050" class="elsevierStylePara elsevierViewall">In contrast to central nervous system involvement, which is common in BD, peripheral nervous system manifestations are rare. There have been isolated cases of Guillain–Barré syndrome, mononeuritis multiplex, sensorimotor neuropathy, autonomic neuropathies and subclinical nerve conduction abnormalities.<a class="elsevierStyleCrossRef" href="#bib0040"><span class="elsevierStyleSup">3</span></a> However, vocal cord involvement is unusual and, to date, only 2 cases have been reported in the medical literature.<a class="elsevierStyleCrossRefs" href="#bib0045"><span class="elsevierStyleSup">4,5</span></a></p><p id="par0055" class="elsevierStylePara elsevierViewall">The most probable explanation for this occurrence could be the presence of vasculitis at the level of the recurrent laryngeal nerve.<a class="elsevierStyleCrossRef" href="#bib0050"><span class="elsevierStyleSup">5</span></a> In the case of this patient we found no other condition to explain the dysphonia.</p><p id="par0060" class="elsevierStylePara elsevierViewall">In conclusion, BD should be taken into account in the differential diagnosis of sudden dysphonia in the absence of other more common findings, especially in regions in which the disease is frequent.</p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Amao-Ruiz E, Correa-Fernández AM, Gallego-Gil J. Parálisis de cuerda vocal como manifestación clínica de enfermedad de Behçet. Reumatol Clin. 2017;13:306–307.</p>" ] ] "multimedia" => array:1 [ 0 => array:7 [ "identificador" => "fig0005" "etiqueta" => "Fig. 1" "tipo" => "MULTIMEDIAFIGURA" "mostrarFloat" => true "mostrarDisplay" => false "figura" => array:1 [ 0 => array:4 [ "imagen" => "gr1.jpeg" "Alto" => 800 "Ancho" => 1600 "Tamanyo" => 113645 ] ] "descripcion" => array:1 [ "en" => "<p id="spar0005" class="elsevierStyleSimplePara elsevierViewall">On the left side, a cross-sectional slice of a cervical CT showing the paramedial position of the left vocal cord (arrow). On the right side, an axial slice showing the same position of the vocal cord (arrow), findings compatible with paralysis.</p>" ] ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0030" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Cogan and Behcet syndromes" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:1 [ 0 => "O. 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Kidd" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1016/S1474-4422(09)70015-8" "Revista" => array:6 [ "tituloSerie" => "Lancet Neurol" "fecha" => "2009" "volumen" => "8" "paginaInicial" => "192" "paginaFinal" => "204" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/19161910" "web" => "Medline" ] ] ] ] ] ] ] ] 3 => array:3 [ "identificador" => "bib0045" "etiqueta" => "4" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Sudden Hoarseness due to unilateral cord vocal paralysis in a patient with Behcet's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:2 [ 0 => "T. Pirildar" 1 => "O. Celik" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1007/s10067-003-0708-3" "Revista" => array:6 [ "tituloSerie" => "Clin Rheumatol" "fecha" => "2003" "volumen" => "22" "paginaInicial" => "254" "paginaFinal" => "255" "link" => array:1 [ 0 => array:2 [ "url" => "https://www.ncbi.nlm.nih.gov/pubmed/14505224" "web" => "Medline" ] ] ] ] ] ] ] ] 4 => array:3 [ "identificador" => "bib0050" "etiqueta" => "5" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Unilateral vocal cord paralysis in a patient with Behcet's disease" "autores" => array:1 [ 0 => array:2 [ "etal" => false "autores" => array:4 [ 0 => "O. Karabudak" 1 => "S. Dogru" 2 => "B. Dogan" 3 => "Y. 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| Year/Month | Html | Total | |
|---|---|---|---|
| 2024 October | 47 | 26 | 73 |
| 2024 September | 80 | 14 | 94 |
| 2024 August | 78 | 40 | 118 |
| 2024 July | 61 | 30 | 91 |
| 2024 June | 67 | 39 | 106 |
| 2024 May | 97 | 27 | 124 |
| 2024 April | 65 | 27 | 92 |
| 2024 March | 62 | 34 | 96 |
| 2024 February | 48 | 17 | 65 |
| 2024 January | 62 | 24 | 86 |
| 2023 December | 62 | 32 | 94 |
| 2023 November | 46 | 20 | 66 |
| 2023 October | 72 | 37 | 109 |
| 2023 September | 94 | 40 | 134 |
| 2023 August | 56 | 15 | 71 |
| 2023 July | 65 | 33 | 98 |
| 2023 June | 67 | 33 | 100 |
| 2023 May | 58 | 22 | 80 |
| 2023 April | 39 | 5 | 44 |
| 2023 March | 96 | 27 | 123 |
| 2023 February | 49 | 30 | 79 |
| 2023 January | 30 | 7 | 37 |
| 2022 December | 71 | 46 | 117 |
| 2022 November | 67 | 20 | 87 |
| 2022 October | 72 | 26 | 98 |
| 2022 September | 64 | 33 | 97 |
| 2022 August | 57 | 40 | 97 |
| 2022 July | 45 | 46 | 91 |
| 2022 June | 46 | 36 | 82 |
| 2022 May | 31 | 37 | 68 |
| 2022 April | 54 | 48 | 102 |
| 2022 March | 36 | 52 | 88 |
| 2022 February | 60 | 28 | 88 |
| 2022 January | 47 | 52 | 99 |
| 2021 December | 30 | 40 | 70 |
| 2021 November | 51 | 40 | 91 |
| 2021 October | 55 | 55 | 110 |
| 2021 September | 93 | 39 | 132 |
| 2021 August | 38 | 42 | 80 |
| 2021 July | 25 | 25 | 50 |
| 2021 June | 27 | 29 | 56 |
| 2021 May | 43 | 38 | 81 |
| 2021 April | 66 | 78 | 144 |
| 2021 March | 40 | 31 | 71 |
| 2021 February | 29 | 14 | 43 |
| 2021 January | 35 | 20 | 55 |
| 2020 December | 33 | 19 | 52 |
| 2020 November | 33 | 23 | 56 |
| 2020 October | 24 | 10 | 34 |
| 2020 September | 32 | 25 | 57 |
| 2020 August | 33 | 20 | 53 |
| 2020 July | 45 | 24 | 69 |
| 2020 June | 31 | 19 | 50 |
| 2020 May | 43 | 13 | 56 |
| 2020 April | 25 | 21 | 46 |
| 2020 March | 12 | 4 | 16 |
| 2020 February | 1 | 0 | 1 |
| 2019 August | 1 | 0 | 1 |
| 2018 December | 2 | 0 | 2 |
| 2018 May | 4 | 0 | 4 |
| 2018 April | 78 | 8 | 86 |
| 2018 March | 90 | 5 | 95 |
| 2018 February | 96 | 8 | 104 |
| 2018 January | 40 | 5 | 45 |
| 2017 December | 76 | 7 | 83 |
| 2017 November | 52 | 14 | 66 |
| 2017 October | 58 | 24 | 82 |
| 2017 September | 70 | 30 | 100 |
| 2017 August | 29 | 20 | 49 |
| 2017 July | 3 | 6 | 9 |
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