In this case report, a 65-year-old female presented with chronic obstructive pulmonary disease, major depressive disorder on risperidone, tardive dyskinesia (TD), and dysphagia presented with worsening shortness of breath. Despite previous hospitalizations for respiratory dyskinesia, her symptoms, including stridor, persisted and required intubation. Laryngoscopy showed paradoxical vocal cord movement, and a diagnosis of vocal cord dysfunction due to TD was made after an extensive negative workup.

This case highlights vocal cord dysfunction as a rare but severe manifestation of TD, often caused by dopamine-receptor antagonists like risperidone. Symptoms such as stridor, dyspnea, and paradoxical vocal cord movements can indicate progressive laryngeal dysfunction. Regular TD screening for patients on long-term antipsychotics is critical, particularly with high-risk medications. Vocal cord dysfunction from TD should be considered in patients with respiratory symptoms and known TD, although it is a diagnosis of exclusion. Botulinum toxin injections every 3 to 6 months are the primary treatment for this rare complication.

Reference: Wittrock E, Boulos N. Tardive Dyskinesia of the Vocal Cords: An Uncommon Cause of tachypnea. CHEST. 2024; 166(4):A2554 – A2555.