Bilateral Vocal Cord Immobility Secondary to Psoriatic Arthritis: A Rare Clinical Case

A man in his late 60s, with a history of psoriatic arthritis, presented with a 10-year history of hoarseness and exertional dyspnea. Flexible laryngostroboscopy demonstrated bilateral true vocal cord immobility resting in paramedian positions with glottic airway space reduction at ~5 to 10 mm on respiration. A contrast-enhanced computed tomography scan of the neck was performed to assess for a lesion along the course of the recurrent laryngeal nerves (RLNs), and it confirmed the findings of vocal cord immobility, evidenced by enlarged pyriform sinus and laryngeal ventricle, medialization and thickening of the aryepiglottic folds, and anteromedial deviation of the arytenoid cartilage, but no lesions along the RLNs. In the absence of structural, neurologic, or malignant causes, the findings were suggestive of cricoarytenoid joint fixation secondary to psoriatic arthritis. While cricoarytenoid arthritis is associated with other rheumatologic conditions, its association with psoriatic arthritis is exceedingly rare, with only 1 previously documented case. Our case highlights the importance of considering psoriatic arthritis in the workup of bilateral vocal cord immobility, particularly in patients with no other identifiable cause.