Abstract Introduction Hydralazine is a well-known cause of drug-induced lupus and has been associated with a variety of systemic adverse effects. Among its rare but documented complications is vocal cord paralysis which typically resolves after discontinuation of the offending medication. However, the paralysis may persist in some cases and become permanent. Case Presentation a 79-year-old female with hypertension and type 2 diabetes mellitus with nephropathy presented with two-week complaints of hoarseness, dysphagia, and facial rash. Notably, her hydralazine dosage was increased a few weeks ago and she had been taking the medication for the past four months. During hospitalization, evaluation by speech pathologist confirmed dysphagia. Otolaryngology team was consulted due to ongoing hoarseness with subsequent laryngoscopy revealing bilateral vocal cord paralysis. Laboratory studies included positive antinuclear antibody and anti-histone antibody. Given the lack of clinical improvement despite discontinuation of hydralazine, prophylactic tracheostomy was performed. Discussion Several case reports had documented similar findings. In most instances, the paralysis resolved following discontinuation of offending medication but symptom may become permanent in rare instances, necessitating further intervention to ensure airway protection and patient safety. The underlying pathophysiology is thought to be related to immune-mediated process such as the deposition of circulating immune complexes leading to vasculitis involving the small vessels supplying laryngeal nerves or direct injury to neuromuscular structures. Given the potential for significant airway compromise, clinicians should consider this rare complication in patients receiving hydralazine who present with new-onset hoarseness or respiratory distress. This abstract is funded by: University of Texas - San Antonio
Ng et al. (Fri,) studied this question.