Anti-MDA5 antibody-positive dermatomyositis complicated by unilateral vocal cord paralysis : A case report
- 1Department of Rheumatology, Jining No. 1 People’s Hospital, Jining, Shandong, China
- 2School of Clinical Medicine, Jining Medical University, Jining, Shandong, China.
Abstract
Rationale:: Hoarseness is a well-recognized feature in patients with anti-melanoma differentiation-associated protein 5 antibody-positive dermatomyositis (MDA5-DM); however, vocal cord paralysis (VCP) is a distinctly uncommon complication. To date, VCP has been rarely reported in MDA5-DM or other inflammatory myopathies, and the limited published cases have described exclusively bilateral cord involvement; unilateral VCP has not been documented. Although Janus kinase inhibitors have shown some effectiveness in treating refractory MDA5-DM, their therapeutic role in VCP remains unclear.
Patient concerns:: A 47-year-old Chinese woman with MDA5-DM had clinical improvement after treatment with glucocorticoids and cyclosporine; then she was discharged. However, 2 day after discharge, she experienced a sudden onset of hoarseness, difficulty swallowing liquids, chest tightness, and shortness of breath.
Diagnoses:: Flexible laryngoscopy showed immobility of the left vocal cord, consistent with left VCP. After ruling out causes such as neck surgery, trauma, and mechanical compression, we determined that the unilateral recurrent laryngeal nerve injury was related to MDA5-DM.
Interventions:: Because of severe gingival hyperplasia and worsening hoarseness, cyclosporine was discontinued and replaced with tacrolimus. Tofacitinib was added, along with voice therapy.
Outcomes:: By day 13, the patient’s hoarseness and choking had improved substantially; by day 20, these symptoms had resolved completely.
Lessons:: Unilateral VCP may represent a rare neurological complication in patients with MDA5-DM. For patients who present with hoarseness, difficulty swallowing liquids, or unexplained worsening of shortness of breath, laryngoscopy should be considered to facilitate early diagnosis. If calcineurin inhibitors are not tolerated or the response is inadequate, adding a Janus kinase inhibitor such as tofacitinib may be considered as part of a comprehensive immunosuppressive regimen; however, because multiple interventions were used concurrently in this case, the independent contribution of tofacitinib to neurological recovery could not be determined.
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BibTeX
@article{luan2026antimda5,
title = {{Anti-MDA5 antibody-positive dermatomyositis complicated by unilateral vocal cord paralysis : A case report}},
author = {Luan Luan and Yingying Ma and Xingjie Dong and Luying Gong and Chunfeng Hou},
journal = {Medicine},
year = {2026},
month = oct,
doi = {10.1097/md.0000000000051405},
url = {https://europepmc.org/article/PMC/PMC13727167},
note = {CC BY},
}
RIS
TY - JOUR
TI - Anti-MDA5 antibody-positive dermatomyositis complicated by unilateral vocal cord paralysis : A case report
AU - Luan Luan
AU - Yingying Ma
AU - Xingjie Dong
AU - Luying Gong
AU - Chunfeng Hou
PY - 2026
DA - 2026/10/30
JO - Medicine
DO - 10.1097/md.0000000000051405
UR - https://europepmc.org/article/PMC/PMC13727167
AB - Rationale:: Hoarseness is a well-recognized feature in patients with anti-melanoma differentiation-associated protein 5 antibody-positive dermatomyositis (MDA5-DM); however, vocal cord paralysis (VCP) is a distinctly uncommon complication. To date, VCP has been rarely reported in MDA5-DM or other inflammatory myopathies, and the limited published cases have described exclusively bilateral cord involvement; unilateral VCP has not been documented. Although Janus kinase inhibitors have shown some effectiveness in treating refractory MDA5-DM, their therapeutic role in VCP remains unclear. Patient concerns:: A 47-year-old Chinese woman with MDA5-DM had clinical improvement after treatment with glucocorticoids and cyclosporine; then she was discharged. However, 2 day after discharge, she experienced a sudden onset of hoarseness, difficulty swallowing liquids, chest tightness, and shortness of breath. Diagnoses:: Flexible laryngoscopy showed immobility of the left vocal cord, consistent with left VCP. After ruling out causes such as neck surgery, trauma, and mechanical compression, we determined that the unilateral recurrent laryngeal nerve injury was related to MDA5-DM. Interventions:: Because of severe gingival hyperplasia and worsening hoarseness, cyclosporine was discontinued and replaced with tacrolimus. Tofacitinib was added, along with voice therapy. Outcomes:: By day 13, the patient’s hoarseness and choking had improved substantially; by day 20, these symptoms had resolved completely. Lessons:: Unilateral VCP may represent a rare neurological complication in patients with MDA5-DM. For patients who present with hoarseness, difficulty swallowing liquids, or unexplained worsening of shortness of breath, laryngoscopy should be considered to facilitate early diagnosis. If calcineurin inhibitors are not tolerated or the response is inadequate, adding a Janus kinase inhibitor such as tofacitinib may be considered as part of a comprehensive immunosuppressive regimen; however, because multiple interventions were used concurrently in this case, the independent contribution of tofacitinib to neurological recovery could not be determined.
SN - 0304-5412
SN - 1536-5964
SN - 0025-7974
ER -