Bilateral Vocal Cord Paralysis Following Influenza A: Case Report

Bilateral vocal cord paralysis (BVCP) is a rare but potentially life-threatening condition. Viral infections such as COVID-19, herpes simplex virus, Epstein-Barr virus, and cytomegalovirus have been widely reported; however, influenza A is a rarely reported cause. We describe a 57-year-old male who developed BVCP following an influenza A infection. Comprehensive investigations, including neuroimaging and nerve conduction studies, ruled out structural, neoplastic, demyelinating, medication-related, and autoimmune causes. A transient CMV viremia was identified but deemed a secondary phenomenon due to immunosuppression. The patient required intubation, intravenous corticosteroid therapy, and ICU care. Vocal cord function gradually improved over several weeks, with complete resolution at 2 months. The temporal relationship, exclusion of other etiologies, and spontaneous recovery are very consistent with a post-viral inflammatory mechanism secondary to influenza A. Clinicians should maintain clinical suspicion for bilateral vocal cord paralysis following influenza A for future practice.