# Prolonged Postoperative Paralysis Following Elective Tonsillectomy: A Case of Pseudocholinesterase Deficiency

**Authors:** Kade Walsh, Shane Smith, Gabriella Manilla, Jatin Ahluwalia, Robert Stachler

PMC · DOI: 10.7759/cureus.98727 · 2025-12-08

## TL;DR

A 19-year-old man experienced prolonged paralysis after surgery due to a rare enzyme deficiency, highlighting the importance of recognizing this condition in medical care.

## Contribution

This case report adds to the understanding of pseudocholinesterase deficiency and its impact on postoperative recovery.

## Key findings

- The patient experienced prolonged postoperative paralysis after tonsillectomy.
- Pseudocholinesterase deficiency was suspected as the underlying cause.
- The case emphasizes the need for awareness and management strategies for this rare condition.

## Abstract

Pseudocholinesterase deficiency is a rare disorder of the enzyme butyrylcholinesterase that can lead to delayed emergence following exposure to depolarizing neuromuscular blocking agents. We report the case of a 19-year-old male who underwent elective tonsillectomy and experienced prolonged postoperative paralysis, suspected to be due to pseudocholinesterase deficiency. The patient had no significant past medical history or family history of the condition. This report highlights the clinical implications of pseudocholinesterase deficiency and discusses strategies for perioperative management.

## Linked entities

- **Diseases:** pseudocholinesterase deficiency (MONDO:0015270)

## Full-text entities

- **Genes:** BCHE (butyrylcholinesterase) [NCBI Gene 590] {aka BCHED, CHE1, CHE2, E1}
- **Diseases:** Pseudocholinesterase Deficiency (MESH:C537417), Paralysis (MESH:D010243)
- **Species:** Homo sapiens (human, species) [taxon 9606]

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Source: https://tomesphere.com/paper/PMC12778881