Paraneoplastic bilateral vocal cord paralysis in a patient with anti-Hu syndrome after receiving nivolumab: Case report and literature review

Bilateral vocal cord paralysis (BVCP), a life-threatening condition often necessitating tracheotomy, has been infrequently reported as a paraneoplastic manifestation. We present the case of a 75-year-old male with small cell lung cancer who experienced distinct episodes of paraneoplastic neurological syndromes. The initial episode, occurring concomitant with the diagnosis of cancer and initiation of chemotherapy, was characterized by epileptic seizures and ataxia, which resolved following treatment with immunotherapy. The subsequent episode, presenting as BVCP, developed after the fourth dose of nivolumab as part of the patient's paraneoplastic syndrome. Brain magnetic resonance imaging revealed bilateral hyperintense lesions in the anterior medulla oblongata on T2/FLAIR-weighted sequences. To the best of our knowledge, this represents the first documented case of paraneoplastic BVCP associated with bilateral bulbar lesions, potentially triggered by immune checkpoint inhibitor therapy.