TY - JOUR T1 - Bilateral vocal fold paresis: the only presenting sign of anti-MUSK antibody myasthenia gravis JF - BMJ Case Reports JO - BMJ Case Reports DO - 10.1136/bcr-2019-234070 VL - 14 IS - 1 SP - e234070 AU - Sam Arman AU - Norman Kock AU - George Mochloulis AU - Gorande Kanabar Y1 - 2021/01/01 UR - http://casereports.bmj.com/content/14/1/e234070.abstract N2 - A previously fit and well 53-year-old man was referred to the otolaryngology clinic with intermittent stridor and was found to have bilateral vocal fold paresis. Subsequent airway compromise necessitated emergency surgical tracheostomy. The man was discharged home with tracheostomy in situ and a diagnosis of idiopathic bilateral vocal cord palsy, as all primary investigations were negative. Neurological disease was suspected following readmission to hospital several weeks later with diplopia. Electromyography and serum antibody testing confirmed a diagnosis of anti-muscle-specific tyrosine kinase antibody positive myasthenia gravis (MuSK-MG); a subset of MG where autoantibodies are directed against MuSK. Resolution of bilateral vocal fold paresis was found 8 months after a short course of immunoglobulin (intravenous immunoglobulin (IVIg)) and daily mycophenolate therapy was commenced. Multidisciplinary teamwork between ear, nose and throat surgeons, neurologists and speech therapists enabled successful decannulation of tracheostomy. The patient has recovered well and remains minimally symptomatic. ER -