CASE REPORT Laryngeal Involvement in Systemic Lupus Erythematosus Report of Two Cases K. Murat Ozcan, MD,* Secil Bahar, MD,* Ibrahim Ozcan, MD,* Lale Pasaoglu, MD,† Engin Sennaroglu, MD,‡ Yasar Karaaslan, MD,§ and Huseyin Dere, MD* Abstract: Systemic lupus erythematosus is a multisystem autoim- mune disorder. Joint and skin involvements are the most frequent presenting features. Laryngeal involvement, however, is extremely rare. Symptoms of laryngeal involvement may range from mild hoarse- ness to life-threatening respiratory distress. In this article, 2 patients with systemic lupus erythematosus and laryngeal involvement are presented. The first patient had hoarseness and noisy respiration, and the second had cough and respiratory distress. Otorhinolaryngological examination revealed laryngeal inflammation in both. Our cases re- sponded well to systemic corticosteroids. Patients with symptoms such as hoarseness, foreign body sensation in throat, and respiratory distress should be evaluated by an otorhinolaryngologist to rule out involvement of the laryngeal structures. Key Words: systemic lupus erythematosus, larynx, joints (J Clin Rheumatol 2007;13: 278 –279) S ystemic lupus erythematosus (SLE) is a multisystem disor- der that is characterized by inflammation induced by auto- antibodies. 1 Arthritis, pleuritis, pericarditis, nephritis, and central nervous system involvement are common. Although relatively common in rheumatoid arthritis, laryngeal involvement is rare in SLE. In this article, 2 patients with laryngeal manifestations of SLE are presented, and the literature is reviewed. CASE REPORT Case 1 A 25-year-old woman with SLE was consulted to an otorhinolaryngology clinic due to hoarseness, noisy respira- tion, and foreign body sensation in her throat. She was diagnosed as SLE by the clinic of rheumatology 5 years ago and was under routine follow-up. She had nephritis, pleuritis, and skin involvement at the time of diagnosis. She had no clinical signs of Sjogren syndrome. Systemic corticosteroids and chloroquine were administered for 4 years and then chloroquine was stopped. She was already on 20 mg/d pred- nisolone. Her first laryngeal symptom was hoarseness and appeared 3 weeks before the visit. Later she had noisy respiration and foreign body sensation in her throat. In her otorhinolaryngological examination, there was no ulceration or other lesions in her oropharynx. In videolaryngostrobo- scopic (VLS) examination, the mucosa overlying the aryte- noids was red and thickened, and the movements of both arytenoids were limited in inspiration and phonation. Bowing was evident in her true vocal folds. Laryngeal computerized tomography (CT) revealed thickening in the aryepiglottic fold and asymmetry of arytenoids (Fig. 1). In laboratory exami- nation, blood sedimentation rate was 71 mm/h (6.00 –15.00), CRP was 27.8 mg/L (0.00 –5.00), leukocytes: 4.94 K/L (4.40 –11.30), hematocrit 36.6% (37.7–53.7), total protein: 66 g/L (64 – 83) ALT: 12 U/L (5– 40), AST: 21 U/L (5– 42), direct Coombs test: negative, ANA: positive, anti-DNA: negative, C3: 1.51 g/L (0.90 –1.80), C4: 0.184 g/L (0.10 – 0.40), SSA and SSB-negative. Systemic corticosteroid dose was increased (prednisolone, 1 mg/kg/d, p.o.), and she in- haled cold steam regularly. Her symptoms regressed in a period of 2 weeks. After treatment, VLS examination was normal except for bowing of the true vocal folds. She is under follow-up since 12 months and has no laryngeal symptoms. Case 2 A 24-year-old woman with a recent diagnosis of SLE and symptoms of hoarseness, foreign body sensation in throat, cough, and respiratory distress for 2 days was consulted to the otorhinolaryngology clinic. In laboratory examination, her blood sedimentation rate was 37 mm/h (6.00 –15.00), CRP: 141 mg/L (0.00 –5.00), RF: 9.88 IU/mL (0.00 –15.00), Leukocyte count: 10.5 K/L (4.40 –11.30), hematocrit: 29% (37.7–53.7), total protein: 73 g/L (64 – 83), ALT: 13 U/L (5– 40), AST: 25 U/L (5– 42), ANA: positive, anti-DNA: negative, C3: 0.75 g/L (0.90 –1.80), and C4: 0.07 g/L (0.10 – 0.40). She was recently diagnosed as SLE with nephritis and central nervous system involvement. She has no sicca symptoms. In otorhinolaryngo- logical examination, there was no ulceration or other lesions in her oropharynx. In VLS examination, the mucosa overlying the arytenoids was red and thickened. The arytenoids seemed asym- metric. In laryngeal CT, the right true vocal fold seemed thick- From the *4th ENT Clinic, †Department of Radiodiagnostics, ‡Clinic of Rheumatology, and §Clinic of Internal Medicine, Ankara Numune Education and Research Hospital, Ankara, Turkey. Reprints: K. Murat Ozcan, MD, Yucetepe sit. A blok. 59/6 06580 Anittepe, Ankara, Turkey. E-mail: kursatmuratozcan@yahoo.com. Copyright © 2007 by Lippincott Williams & Wilkins ISSN: 1076-1608/07/1305-0278 DOI: 10.1097/RHU.0b013e318157f25e JCR: Journal of Clinical Rheumatology • Volume 13, Number 5, October 2007 278