The University of Toledo Translation Journal of Medical Sciences 
Internal Medicine Abstract, Department of Medicine Research Symposium UTJMS 2023 May 5; 11(1):e1-e1 

Vocal Cord Palsy and Neutropenia: 
Unusual Presentation of B-12 Deficiency in 
Adult Patient, A Case Report 
Abdulmajeed Alharbi, MD1*, Brandon Speedy, MS1, Sadikshya Sharma1, Samantha 
David, MD1, Li Wang, MD1, Ruby Nucklos, MD1

1Division of Internal Medicine , Department of Medicine, The University of Toledo, 
Toledo, OH 43614 

*Corresponding author: Abdulmajeed.Alharbi@utoledo.edu

Published: 05 May 2023 

Background: Vitamin B12 deficiency commonly causes megaloblastic anemia and rarely pancytopenia. 
Manifestations of anemia may include gastrointestinal and neurological symptoms which can persist if 
not treated immediately.   

Case Presentation: Patient is a 67-year-old male who presented with  severe leukopenia. The lab work 
was subsequent to a 6-week-course of cefepime for osteomyelitis. On arrival, the patient endorsed 
pharyngitis, dyspnea, cough productive of clear sputum, and headaches present for 5 days. Initial 
workup redemonstrated severe leukopenia (WBC: 2.2) with an Absolute Neutrophil Count of 0.  The 
next day, the patient was experiencing dysphagia with thick, white oral secretions that required 
suctioning and had a strong productive cough. Video swallow study demonstrating severe impairment of 
pharyngeal swallow with gross aspiration.  The patient’s blood culture, sputum culture, and RPP all 
come back within normal limits.  On the 6th day of admission, the patient’s WBC improved to 10.2 and 
his Absolute Neutrophil Count was 5.8.  He could communicate well, and his dysphagia and dysphonia 
improved. Repeat Video Swallow Study on day 7 demonstrated only mild oral and pharyngeal phase 
dysphagia and repeat laryngoscopy revealed normal right vocal cord with persistent left vocal cord 
paralysis.    

Conclusion: B12 deficiency may present in wide different ways. This case highlights the fact that 
manifestations of vitamin B12 deficiency can be highly variable and underscores the need to keep this 
disorder on the differential diagnosis in a variety of clinical presentations. Clinicians should be aware of 
different hematological and neurological presentations. 

https://dx.doi.org/10.46570/utjms.vol11-2023-689 

https://dx.doi.org/10.46570/utjms.vol11-2023-689
mailto:Abdulmajeed.Alharbi@utoledo.edu