Hydralazine-induced lupus and vocal fold paralysis

Abstract

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.

Left Vocal Cord Paralysis in Cases of Systemic Lupus erythematosus

“…In 8 of the 15 cases (53%), vocal cord paralysis and its symptoms occurred or were discovered at the early stage of SLE, that is, before the treatment with steroids was started [1,3,4,7,[9][10][11][12]. Furthermore, laryngeal involvement was one of the first clinical manifestations of SLE in 5 cases (33%) [1,3,[9][10][11]. The only case in which pulmonary hypertension was proved to be the cause of the vocal cord paralysis [8] and 2 [6] of 3 cases [6,15] of SLE complicated by pulmonary hypertension manifested vocal cord paralysis during the therapy for SLE, at least 2 years after treatment with steroids had been started.…”

“…during the period when SLE was inactive. There were reports of 5 patients suffering from right vocal cord paralysis [3,4,7,11,14], 6 from left vocal cord paralysis [1,2,6,8,10,15] and 4 bilaterally [9,12,13]. Besides vocal cord paralysis, arytenoiditis [1,2,[11][12][13], edema of aryepiglottic [1,11] and vocal folds [11] and the posterior commissure [13] were also observed in the larynx.…”

“…There were reports of 5 patients suffering from right vocal cord paralysis [3,4,7,11,14], 6 from left vocal cord paralysis [1,2,6,8,10,15] and 4 bilaterally [9,12,13]. Besides vocal cord paralysis, arytenoiditis [1,2,[11][12][13], edema of aryepiglottic [1,11] and vocal folds [11] and the posterior commissure [13] were also observed in the larynx. The proposed causes of vocal cord paralysis are vasculitis of the vasa nervorum [3,4,6,7,9,14], neuritis [7], thromboembolic effect on recurrent laryngeal nerves [9], laryngeal lupus including arytenoiditis and cricoarytenoid arthritis [2,10,[11][12][13] and compression of the left recurrent laryngeal nerve by an enlarged left pulmonary artery [6,8,15].…”

“…Besides vocal cord paralysis, arytenoiditis [1,2,[11][12][13], edema of aryepiglottic [1,11] and vocal folds [11] and the posterior commissure [13] were also observed in the larynx. The proposed causes of vocal cord paralysis are vasculitis of the vasa nervorum [3,4,6,7,9,14], neuritis [7], thromboembolic effect on recurrent laryngeal nerves [9], laryngeal lupus including arytenoiditis and cricoarytenoid arthritis [2,10,[11][12][13] and compression of the left recurrent laryngeal nerve by an enlarged left pulmonary artery [6,8,15]. However, except for the case reported by Asherson and Hughes [6], these were all speculative and have never been clarified.…”

Left vocal cord paralysis in systemic lupus erythematosus

“…Hari et al described a case of drug-induced lupus and vocal fold paralysis. Many drugs are known to produce a lupus-like syndrome; in this case, hydralazine was deemed the causative agent [7]. Arthralgia responded to cessation of hydralazine, in addition to the ESR; however, there was a period of four months before the vocal cord paralysis was seen to resolve.…”