British Journal of Dermatology (1977) 96, 211.

Systemic lupus erythematosus presenting as a recurrent sore throat and oral ulceration: a case report SHEILA M.O'NEILL, JOHN THOMSON, ALEXANDRA M.M.STRONG AND * WILLIAM LANG Departments of Dermatology and * Otolaryngology, Glasgow Royal Infirmary, Glasgow Accepted for publication 11 July 1976

SUMMARY

A patient is described who presented with a 2-year history of repeated sore throats and associated oral ulceration. These were shown to be due to systemic lupus erythematosus (SLE). There was no clinical evidence of involvement of any other system. We are not aware of a previous report of SLE presenting in this manner.

Oral ulceration in known cases of systemic lupus erythematosus (SLE) is recognized (McCarthy & Shklar, 1964). The association of gingivitis and sore throats in established SLE has also been noted (Edwards Gayford, 1971). However, SLE presenting as a recurrent painful throat and repeated bouts of oral ulcers does not seem to have been recorded. CASE REPORT

The patient, a 65-year-old woman, was referred to the Ear, Nose & Throat Department for investigation of intermittent pain in the throat and blistering ulceration of the oral mucosa occurring over a period of 2 years. The throat pain, likened by the patient to that caused by a firmly lodged fish bone, was situated in the laryngeal area of the throat. This symptom and the concomitant oral ulceration would persist for 2 to 4 weeks and gradually subside leaving the patient asymptomatic for periods varying from a few days to 6 weeks. On occasions mild dysphagia and hoarseness accompanied the above. She had no other symptoms. Routine systemic enquiry, past and family history were essentially negative. At the initial consultation the patient was asymptomatic and clinical examination revealed no signs of any disease process. When seen 3 months later she had blisters and erosions on the soft palate, buccai mucosa, floor of the mouth and on the free edge of the epiglottis. A dermatological opinion was sought. No past history of a rash was elicited and the skin was normal on examination. A tentative diagnosis of pemphigus was made and a series of investigations organized. The results are detailed in Table i. 211

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S.M.O'Neill et al. TABLE I

Haemoglobin White blood cell count Erythrocyte sedimentation rate Urea and electrolytes Liver function tests L.E. latex Anti-nuclear factor Deoxyribonucleic acid binding capacity Herpes simplex titre Viral culture from an oral blister Bacteriological examination of a swab from the oral ulcers Mycological examination for Candida albicans Urine examination for sugar, protein & blood X-ray of the soft tissues of the neck Barium swallow and meal

I 2 i g% 6100 cells/c mm 58 mm in the ist hour Normal Normal Negative Positive 1:256 (homogeneous) 53 0% (Normal

Systemic lupus erythematosus presenting as a recurrent sore throat and oral ulceration: a case report.

British Journal of Dermatology (1977) 96, 211. Systemic lupus erythematosus presenting as a recurrent sore throat and oral ulceration: a case report...
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