A Middle-aged Man with Dyspnea and Hoarseness: An Unusual Case of Vocal Cord Paralysis

Background: Pleuroparenchymal fibroelastosis (PPFE) is a rare and distinct form of interstitial pneumonia predominantly affecting the upper lung zones. It is characterized by fibrotic thickening of the visceral pleura and adjacent subpleural parenchyma. While common complications include spontaneous pneumothorax and pneumomediastinum, vocal cord paralysis (VCP) or paresis has been increasingly recognized as a potential manifestation in recent reports. This case highlights the unique association between idiopathic PPFE (IPPFE) and VCP, emphasizing its novelty and clinical relevance. Case presentation: We report a case of a middle-aged man presenting with progressive dyspnea, hoarseness, and left-sided vocal cord paralysis. Imaging studies revealed upper lobe-dominant fibrotic changes consistent with IPPFE. A comprehensive evaluation ruled out secondary causes of PPFE and other potential etiologies of VCP. Despite supportive management, the patient’s VCP persisted, likely due to architectural distortion of the lung affecting the recurrent laryngeal nerve pathway. Conclusions: This case adds to the limited but growing body of literature on the association between PPFE and VCP. Understanding this rare complication is crucial for early recognition and appropriate management, as it highlights the diverse clinical manifestations of PPFE and its impact on patient outcomes.