A 48-year-old woman with body mass index of 36 kg/m2 presented three months after mild (cough and sore throat) severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection with intermittent shortness of breath refractory to inhalers and episodes with inability to take a deep breath. Cardiopulmonary examination and lung volumes were normal. Spirometry showed flattening of inspiratory and expiratory curve at 3 and 9 months after positive SARS-CoV-2 (Figures 1A and 1B). DL CO was 64% (of reference) but uninterpretable due to poor maneuver. Paired inspiratory–expiratory chest computed tomography scan was normal. Flexible video-endoscopy revealed normal abduction of vocal cords during breathing at rest and adduction during phonation (Figures 1C and 1D). However, when cued to take a deep breath, almost complete vocal cord adduction and pharyngeal wall contraction was observed (Figures 1E and 1F). The vocal cord dysfunction (VCD) questionnaire score was 36/60 (⩽12 is considered normal) (1). Although our report has the limitation of not having objectively measured the patient’s dyspnea, this case and another recently reported case of post–SARS-CoV-2 dyspnea and inspiratory stridor highlights the importance of recognizing VCD or episodic laryngeal breathing disorders as one of the causes for difficulty breathing months after coronavirus disease (COVID-19) (2). Post–viral VCD has been described previously (3). Our patient was counseled and educated about the breathing strategies by a speech and language therapist (4, 5).
Figure 1.
Flow volume loops at (A) 3 months and (B) 9 months after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection showing flattening of inspiratory and expiratory curve (gray area indicates the upper and lower limit of normal reference range). Flexible video endoscopy done at 9 months after SARS-CoV-2 infection showing abducted view of vocal cords during (C) normal breathing at rest and (D) adducted vocal cords during phonation. However, when cued to take a deep breath, almost complete (E) vocal cord adduction and (F) pharyngeal wall contraction was observed.
Footnotes
Author Contributions: All authors contributed to data collection, design, and writing.
Originally Published in Press as DOI: 10.1164/rccm.202106-1384IM on June 1, 2022
Author disclosures are available with the text of this article at www.atsjournals.org.
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