CASE REPORT - Upper Airway Obstruction From Cricoarytenoiditis as the Presenting Manifestation of a SLE Flare

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Severe Upper Airway Obstruction From Cricoarytenoiditis as the Sole

Presenting Manifestation of a Systemic Lupus Erythematosus Flare*

Anita Karim, MD; Shahid Ahmed, MD; Rina Siddiqui, MD; Galina S. Marder, MD

and ph Mattana, MD

* From the Long Island Jewish Medical Center (Drs. Karim, Ahmed, Marder, and

Mattana), New Hyde Park, NY, the Long Island Campus for the Albert Einstein

College of Medicine, Bronx, NY; and the Department of Pathology (Dr.

Siddiqui), St. Luke's-Roosevelt Hospital, New York, NY.

Correspondence to: ph Mattana, MD, Department of Medicine, Long Island

Jewish Medical Center, New Hyde Park, NY 11040; e-mail: mattana@...

Upper airway obstruction due to laryngeal involvement is a known

complication of systemic lupus erythematosus (SLE). Laryngeal involvement

typically accompanies inflammatory activity involving other sites and varies

from mild mucosal inflammation to bilateral vocal cord immobility.

Cricoarytenoid arthropathy is a rare cause of severe airway obstruction in

patients with SLE and almost always occurs in the presence of other

associated symptoms. Furthermore, in contrast to patients with rheumatoid

arthritis, in whom chronic involvement of cricoarytenoid joints occurs more

commonly and often requires surgical intervention, patients with SLE

typically present with acute arthritis of cricoarytenoid joints and respond

to corticosteroid therapy alone. We describe a patient with known SLE who

presented with severe acute upper airway obstruction as the sole

manifestation of active SLE after several years of quiescence. The laryngeal

involvement progressed from mucosal inflammation to acute

cricoarytenoiditis, despite the administration of high-dose corticosteroid

therapy, necessitating emergent intubation and tracheostomy. This case

illustrates the importance of considering SLE in the differential diagnosis

of patients presenting with acute upper airway obstruction.

http://www.chestjournal.org/cgi/content/abstract/121/3/990

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Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org