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CASE REPORT
Mandibular resorption and vocal cord paralysis: a catastrophic form of systemic sclerosis
  1. Pedro Mendonça1,2,
  2. Anna Viola Taulaigo1,
  3. Antonio Caetano3 and
  4. Maria Francisca Moraes-Fontes1
  1. 1 Unidade de Doenças Auto-imunes/Medicina 7.2, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
  2. 2 Serviço de Medicina, Hospital de Faro, Centro Hospitalar Universitário do Algarve, Faro, Portugal
  3. 3 Serviço de Radiologia, Hospital de Curry Cabral, Centro Hospitalar de Lisboa Central, Lisboa, Portugal
  1. Correspondence to Dr Anna Viola Taulaigo, annataulaigo{at}gmail.com

Abstract

Sudden respiratory distress in association with severe weight loss are unusual features of systemic sclerosis (SSc). We report the case of a 56-year-old Caucasian woman with a 9-year history of a diffuse form of SSc who presented with acute stridor due to vocal cord paralysis and required an emergency tracheostomy. She had sought medical attention only after 4 years of disease onset, presenting with a mask-like face, diffuse skin thickening, acro-osteolysis and severe interstitial lung disease. Even though skin tightness improved after immunosuppressive treatment, several spontaneous facial fractures and episodes of dysphagia and choking occurred in the years that followed. At the time of stridor, she was severely malnourished and a percutaneous endoscopic gastrostomy was required for feeding. Permanent vocal cord damage in combination with severe loco-regional bone resorption resulted in severe disability and impaired nutrition. We hereby highlight the features of SSc for which therapy remains challenging.

  • rheumatology
  • connective tissue disease
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Footnotes

  • PM and AVT contributed equally.

  • Contributors AVT, PM and MFM-F conceived the work. AVT, PM and AC collected the data and AC especially contributed to images selection and interpretation. AVT and PM drafted the article. All the authors critically revised the work and gave final approval of the version submitted. AVT and PM contributed equally to this paper.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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