Prolonged bilateral vocal cord paralysis as an isolated sequela of fulminant Guillain-Barré syndrome after Campylobacter jejuni enteritis

Background Guillain-Barré syndrome (GBS) rarely presents with bilateral vocal cord paralysis (BVCP), and persistent BVCP as an isolated long-term sequela is exceptionally uncommon. We describe the clinical course of fulminant axonal GBS complicated by prolonged BVCP and discuss its implications for airway management. Case presentation A previously healthy man in his early 50s developed rapidly progressive tetraplegia, multiple cranial neuropathies and respiratory failure several days after an episode of enteritis, ultimately progressing to a near-locked-in state. Anti-GT1a IgG antibodies were strongly positive, and serology was consistent with recent C. jejuni infection. Despite immunotherapy and near-complete recovery of limb strength and bulbar function, serial laryngoscopy demonstrated persistent BVCP with vocal cords fixed in the paramedian position, precluding decannulation and necessitating long-term tracheostomy. Conclusion BVCP may persist as the sole disabling sequela even after marked systemic motor recovery in severe axonal GBS, potentially reflecting the length-dependent vulnerability and protracted reinnervation of the recurrent laryngeal nerve. Upper airway evaluation should be incorporated into ventilator weaning protocols and tracheostomy management, particularly in severe GBS.