Systemic lupus erythematosus (SLE) is a multi-system autoimmune disorder that can affect the upper airway. Hydralazine has been known to cause a lupus-like syndrome that can produce the clinical manifestations of SLE. We discuss a case of hydralazine-induced lupus, presenting with acute laryngeal oedema and right vocal fold paralysis. Cessation of hydralazine therapy resulted in reversal of paralysis.

A 51-year-old woman complained of hoarseness of two years duration. The patient's past medical history was significant for autoimmunological hepatitis and arthritis for which she had not received treatment. Laryngoscopy and laryngeal stroboscopy revealed ‘bamboo joint-like nodules’ on both true vocal folds. These nodules resembled rheumatoid nodules and were suggestive of a collagen disease. Previous reports have documented that the treatment for such conditions related to collagen diseases is surgical resection. However, we initially attempted to treat the laryngeal lesions systemically with prednisolone. The hoarseness and the bamboo-like nodules disappeared six months after the treatment. Furthermore, the liver function test returned to normal and arthritis completely resolved. Based on our patient's response to this treatment, we diagnosed atypical-SLE and a lupus laryngitis. This case suggests that studies of the larynx may be helpful in the early diagnosis of collagan diseases and that such conditions may respond to systemic treatment.