Bilateral Vocal Cord Palsy as the Sole Presentation of Acquired Syphilis
Journal name: The Malaysian Journal of Medical Sciences
Original article title: Bilateral Vocal Cord Palsy as the Sole Presentation of Acquired Syphilis
The Malaysian Journal of Medical Sciences (MJMS) is a peer-reviewed, open-access journal published online at least six times a year. It covers all aspects of medical sciences and prioritizes high-quality research.
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Original source:
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Zamzil Amin Asha’ari, Mohd Sayuti Razali, Raja Ahmad RL Ahmad
The Malaysian Journal of Medical Sciences:
(A peer-reviewed, open-access journal)
Full text available for: Bilateral Vocal Cord Palsy as the Sole Presentation of Acquired Syphilis
Year: 2010
Copyright (license): CC BY 4.0
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Summary of article contents:
Introduction
Bilateral vocal cord palsy is typically associated with neck surgeries, especially involving the thyroid. However, this case report highlights an unusual presentation of bilateral vocal cord palsy as the sole manifestation of acquired syphilis in a 45-year-old Malay woman. The rising incidence of syphilis worldwide suggests that healthcare providers may encounter such atypical presentations increasingly. This case serves as a reminder of the importance of considering syphilis in differential diagnoses for vocal cord issues.
Granulomatous Laryngitis Due to Syphilis
In this patient's presentation, she exhibited significant airway obstruction, marked stridor, and vocal changes, which led to emergency evaluation. Indirect laryngoscopy revealed that both vocal cords were fixed in a paramedian position, with granulomatous lesions present. A biopsy indicated foreign body-type giant cell granulomatous laryngitis, which raised concerns for various differential diagnoses, notably tuberculosis. However, extensive testing—including cultures and stains—yielded negative results, allowing for the identification of Treponema pallidum antibodies and a positive VDRL test. The final diagnosis was bilateral vocal cord fixation secondary to tertiary gummatous laryngeal syphilis, underscoring the potential for syphilis to present solely in the laryngeal region.
Conclusion
This case emphasizes that laryngeal involvement in syphilis, while rare, can manifest as isolated symptoms without broader systemic features. Given the resurgence of syphilis infections globally, clinicians must remain vigilant for this atypical presentation when diagnosing patients with vocal cord dysfunction or respiratory distress. The management of this patient included emergency tracheostomy and targeted antibiotic therapy, which successfully alleviated her symptoms and secured her airway, demonstrating the importance of thorough diagnostics and appropriate surgical interventions in such cases.
FAQ section (important questions/answers):
What is bilateral vocal cord palsy and what causes it?
Bilateral vocal cord palsy is the immobilization of both vocal cords, commonly caused by surgical injury, particularly during neck surgeries, such as thyroid operations. Other rare causes include infections like tuberculosis and syphilis.
How did the patient present with syphilis-related vocal cord issues?
The 45-year-old patient presented with noisy breathing, stridor, and husky voice. Upon examination, both vocal cords were immobilized, leading to emergency surgery for airway obstruction, with biopsy revealing gummatous laryngeal syphilis as the underlying cause.
What treatments were provided to the patient with laryngeal syphilis?
The patient underwent emergency tracheostomy for airway management and received intravenous procaine penicillin for syphilis. A laser posterior cordectomy was performed due to the severity of vocal cord damage.
How prevalent is syphilis and its unusual presentations in the population?
Syphilis incidence is rising globally, leading to rare manifestations, including isolated laryngeal involvement. This serves as a reminder for clinicians to consider uncommon presentations in diagnosis and treatment.
Glossary definitions and references:
Scientific and Ayurvedic Glossary list for “Bilateral Vocal Cord Palsy as the Sole Presentation of Acquired Syphilis”. This list explains important keywords that occur in this article and links it to the glossary for a better understanding of that concept in the context of Ayurveda and other topics.
1) Disease:
The term 'disease' refers to a pathological condition that causes dysfunction within an organism. In the context of this case report, acquired syphilis is highlighted as a rare but significant underlying disease causing bilateral vocal cord palsy, showcasing the importance of identifying and treating uncommon manifestations of prevalent diseases.
2) Tuberculosis:
Tuberculosis (TB) is mentioned as a significant differential diagnosis due to the patient’s history and the potential for granulomatous infections to affect the larynx. TB is a well-known infectious disease that can lead to severe respiratory issues, necessitating careful evaluation in patients with similar symptoms.
3) Antibiotic (Antibacterial):
The use of antibiotics, particularly procaine penicillin in this case, is crucial for treating bacterial infections like syphilis. Antibiotics can help manage not only the syphilitic infection but also prevent further complications associated with secondary damage to the airway, emphasizing rigorous treatment protocols in otolaryngology.
4) Post:
The term 'post' in this context typically refers to the recovery and follow-up phase after medical or surgical intervention. In the report, it highlights the importance of monitoring results post-procedure, such as the patient's progress regarding airway improvement and serology test results, including VDRL.
5) Fixation:
Fixation here refers to the immobilization of the vocal cords due to gummatous changes from syphilis. This pathology results in significant airway obstruction, demonstrating the need for prompt diagnosis and intervention to restore normal vocal cord function and ensure patient safety from respiratory distress.
6) Blood:
Blood tests are essential for diagnosing syphilis, particularly through serological tests like VDRL which detect antibodies against Treponema pallidum. In this report, blood work corroborated the diagnosis and guided treatment, showcasing the critical role of laboratory evaluations in infectious disease management.
7) Medicine:
'Medicine' in this case encompasses the broader field of medical science involved in diagnosing, treating, and managing diseases like syphilis. It underscores the interdisciplinary approach required in treating complex cases that present atypically, encouraging practitioners to utilize comprehensive medical knowledge for effective patient care.
8) Swelling:
While swelling of the neck or surrounding structures is often associated with laryngeal diseases, the patient notably did not present with this symptom. The absence of swelling is relevant as it differentiates the condition from other potential causes of airway obstruction, necessitating focused diagnostic efforts.
9) Epidemic:
The term 'epidemic' relates to widespread occurrences of a disease within a population. This report references the historical context of syphilis prevalence, indicating a resurgence of cases, which alerts clinicians to the importance of considering syphilis in differential diagnoses of uncommon symptoms.
10) Delusion (Deluded):
Delusions may manifest in patients with neurosyphilis, indicating the importance of understanding the psychiatric and neurological implications of advanced syphilis. This knowledge can impact the interpretation of behavioral and cognitive symptoms in systemic diseases, reinforcing the need for comprehensive patient assessments.
11) Writing:
Writing in a clinical context relates to documenting patient cases, sharing findings, and communicating effectively among medical professionals. The meticulous account of the patient’s symptoms, diagnostic process, and treatment serves as an educational resource for clinicians facing similar challenges in practice.
12) Quality:
Quality refers to the functional outcomes of voice and airway management post-intervention. The patient’s follow-up indicated an improvement in her quality of life, highlighting the effectiveness of surgical and medical treatments in restoring normal function and reducing complications post-syphilis management.
13) Account:
The ‘account’ denotes the detailed case report provided for educational and clinical review. Such accounts are significant in sharing knowledge among healthcare practitioners, helping them recognize rare disease presentations and learn effective diagnostic and treatment strategies based on real-world experiences.
14) Vertigo:
Vertigo, as a neurological symptom, could be associated with advanced stages of syphilis affecting the central nervous system. Awareness of such presentations underscores the necessity for clinicians to evaluate a range of symptoms and potential complications in managing patients with syphilis.
15) Repair:
Repair refers to the surgical intervention performed to restore vocal cord function. In the case report, the decision for surgical repair, specifically posterior cordectomy, highlights management choices available to address severe airway compromise and vocal cord injuries caused by syphilis.
16) Desire:
Desire reflects the patient’s expressed wish to avoid long-term tracheostomy, which influences medical decision-making. Understanding patient desires is crucial in guiding treatment pathways and ensuring that interventions align with their preferences while also considering clinical indications.
17) Arrow:
In the context of this case, 'arrow' likely refers to the indication in the imagery of vocal cord lesions, suggesting targeted areas of pathology. The visual representation aids in the diagnostic process, enabling clinicians to visualize and identify affected areas for further evaluation.
18) Antal (Āṇṭāl, Āṇḍāl, Andal):
Antal refers to a cited author in the literature review segment discussing granulomatous diseases. Acknowledging contributions from various scholars fosters a comprehensive understanding of diseases and underpinning conditions, encouraging the integration of collective research findings into clinical practice for better patient outcomes.
Other Science Concepts:
Discover the significance of concepts within the article: ‘Bilateral Vocal Cord Palsy as the Sole Presentation of Acquired Syphilis’. Further sources in the context of Science might help you critically compare this page with similair documents:
Medical science, Surgical intervention, Clinical examination, Medical history, Foreign body, General practitioner, Sexual contact, Pulmonary tuberculosis, Case report, Airway obstruction, Emergency Surgery, Oral mucosa, Written informed consent, Medical management, Vocal cord palsy, Blood investigation, Surgical repair, Head and neck, Tuberculosis diagnosis, General anaesthesia, Differential diagnoses, Primary syphilis, Treponema pallidum, Cerebrospinal fluid analysis, Blood examination, Tracheostomy, Carbon dioxide laser, Post-operative course, Ministry of Health Malaysia, Unusual presentation, Endemic countries, Temporal trends, Antibiotic era, Airway patency, Granuloma.
Concepts being referred in other categories, contexts and sources.