Progressive swelling of the tongue and face in a 35-year-old woman in the emergency room

Introduction Lupus erythematosus is a rare chronic inflammatory autoimmune disease belonging to the group of collagenoses. Autoantibodies are formed, which destroy components of the cell nucleus. This leads to inflammatory damage to the vascular connective tissue. Cutaneous and systemic lupus erythematosus are distinguished. Both forms can present themselves very variably and thus complicate the confirmation of a diagnosis. The cause is largely unknown, but a multifactorial development process is being discussed.

Case Report A 35-year-old patient presented to the emergency room with worsening of the general condition, B symptoms and anemia. A day later she developed marked tongue swelling with tenderness, trismus and cervical lymphadenopathy. She was presented to the ENT department to rule out angioedema. There was a suspected vasculitis DD abscess of the tongue, so a computed tomography of the neck with contrast agent was performed and furthermore a tissue biopsy was taken. An abscess could thereby be excluded. Histologically, a leukocytoclastic vasculitis of the tongue mucosa was found. In summary of the findings, the diagnosis of systemic lupus erythematosus was confirmed using the current ACR/EULAR criteria.

Conclusion Acute tongue swelling can have a variety of causes. An interdisciplinary clarification with the participation of ENT is therefore obligatory. In the present case, the sampling of the tongue with the detection of vasculitis brought an important aspect for the diagnosis of a disease of the rheumatoid type. Furthermore, a vasculitis of the skin was confirmed histologically and thus an involvement of multiple organs could be confirmed.

Publication History

Article published online:
27 June 2023