Unexpected Vocal Cord Paralysis and Myasthenia Gravis in a Patient with Squamous Cell Lung Cancer

Vocal cord paralysis is a voice disorder that occurs when one or both the vocal cords don’t open or don’t close properly. This often determines difficulty in swallowing and coughing by the patient, because food or liquids slip into the trachea and the lungs. Vocal cord paralysis may be caused by trauma, cancer, surgery, or intubation and it has been sometimes described to follow vinca alkaloid treatment. Myasthenia gravis is an autoimmune disorder that can represent a paraneoplastic syndrome in cancer patients. We report a 55-years-old male with an advanced squamous cell lung carcinoma, presenting a unilateral vocal cord paralysis immediately after the treatment with gemcitabine, and myasthenia gravis one week after. To date, there aren’t any data in the literature describing causal relationship between non small cell lung cancer and myasthenia gravis; here we suggest that myasthenia gravis simultaneous to lung cancer might be a rare form of paraneoplastic syndrome. It is impossible to find a single cause for our patient vocal cord paralysis: it could in fact have a multifactorial pathogenesis, not excluding the possibility of a single rare paraneoplastic syndrome, which includes both myasthenia gravis and vocal cord paralysis.