Systemic Lupus Erythematosus

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FIGURE 2 Rheumatoid nodule on left vocal fold with reactive changes on right vocal fold.

SLE is a common autoimmune connective-tissue disease affecting 1 in 1000. It is much more prevalent in young females, with a female-to-male incidence of 9:1. It affects many organ systems. Skin rash is a very common presentation, typically appearing in the malar areas following sun exposure. Oral ulcerations develop in 40% of patients. Other systemic manifestations include myocarditis, nephritis, pneumonitis, and central nervous system (CNS) involvement.

Laryngeal involvement is rare in SLE, but hoarseness in the presence of characteristic signs and symptoms should raise suspicion of possible SLE. The cause of hoarseness in SLE patients is varied. One review of 97 SLE patients with laryngeal

Rheumatoid Vocal Nodules

FIGURE 2 Rheumatoid nodule on left vocal fold with reactive changes on right vocal fold.

involvement found laryngeal edema in 28% and laryngeal paralysis in 11% (5). Less frequent involvement includes epiglottitis, subglottic stenosis, and rheumatoid nodules. Some patients develop stridor due to inflammatory lesions in the larynx and trachea. Biopsy of active lesions may aid in diagnosis by demonstrating mononuclear inflammation and immunofluorescent nuclear staining.

The clinical course of SLE is unpredictable. Treatment primarily consists of steroids. Please see Chapter 1 for discussion in detail of SLE.

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