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Vincristine-induced Vocal Cord Palsy: Case Report and Review of the Literature

Latiff, Zarina Abdul MBBS, MMed, MSc*; Kamal, Nor Azlin MRCPCH*; Jahendran, Jeevanan MS (ORL-HNS); Alias, Hamidah MMed*; Goh, Bee See MS (ORL-HNS); Syed Zakaria, Syed Zulkifli MMed, PhD*; Jamal, Rahman MRCP, PhD*

Journal of Pediatric Hematology/Oncology: July 2010 - Volume 32 - Issue 5 - p 407-410
doi: 10.1097/MPH.0b013e3181e01584
Clinical and Laboratory Observations

Vincristine-induced vocal cord paralysis is a rare but serious complication. We report 2 patients with acute lymphoblastic leukemia who developed progressive stridor during induction chemotherapy. There were no clinical features of peripheral or autonomic neuropathy. Flexible laryngoscopy confirmed the diagnosis of bilateral vocal cord palsy; interestingly, the nerve conduction test revealed axonal motor neuropathy involving the median and common peroneal nerves in both patients. The first patient required prolonged ventilatory support necessitating unilateral cordectomy before extubation, whereas the second only required supplemental oxygen therapy. There was resolution of stridor in the first patient after cordectomy and gradual clinical improvement in the second. These cases illustrate that a high index of suspicion of vincristine-induced vocal cord palsy with prompt otolaryngology consultation for laryngoscopy is required in the diagnostic evaluation of a patient who has received vincristine.

Departments of *Pediatrics

Otorhinolaryngology, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latif, Cheras, Kuala Lumpur, Malaysia

Reprints: Zarina Abdul Latiff, MBBS, MMed, MSc, Department of Pediatrics, Faculty of Medicine, Universiti Kebangsaan Malaysia Medical Centre, Jalan Yaacob Latiff, 56000 Cheras, Kuala Lumpur, Malaysia (e-mail: zarinaal@ppukm.ukm.my).

Received for publication August 25, 2009; accepted March 5, 2010

© 2010 Lippincott Williams & Wilkins, Inc.