Unveiling the Uncommon: Systemic Lupus Erythematosus with Dual Peculiarities—Vocal Fold Paralysis and a Winged Scapula

Abstract

This case report highlights 2 uncommon presentations of systemic lupus erythematosus (SLE): winged scapula and unilateral vocal fold paralysis. A 44-year-old Emirati gentleman diagnosed with SLE presented with a 3-month history of gradual loss of voice and weakness in the right upper extremity. Clinical examination unveiled incomplete glottic closure due to right vocal fold paralysis. Additionally, there was restricted movement in the right arm and noticeable winging of the right scapula. Subsequent investigations indicated that the involvement of the recurrent laryngeal nerve and long thoracic nerve was attributed to SLE. The treatment plan included administering intravenous immunoglobulin at a dosage of 2 mg/kg over 3 days, followed by 2 doses of rituximab at 1 g each, spaced 2 weeks apart. These interventions were complemented by the patient’s baseline SLE treatment regimen, including mycophenolate mofetil at 1 g daily and hydroxychloroquine at 200 mg daily. Following 3 months of initiating immunosuppressive therapy, substantial compensation was observed in the right vocal fold paralysis, demonstrating full glottic closure and only minor limitations in full abduction at the right shoulder. This case underscores the rarity of peripheral nervous system involvement in SLE, revealing a significant clinical challenge in diagnosing and managing affected patients. It underscores the imperative for more precise diagnostic criteria to effectively guide clinical decisions, particularly in light of the complexity of these presentations.

Cite this article as: Namas R, Al Qassimi S, Jamal Teir H, et al. Unveiling the uncommon: systemic lupus erythematosus with dual peculiarities— vocal fold paralysis and a winged scapula. Eur J Rheumatol. 2025, 12(3), 0104, doi: 10.5152/eurjrheum.2025.24104.