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June 2012Presentation: A 38-year-old woman presented with a chief complaint of throat pain of four weeks duration and hoarseness of several years duration. She eventually presented to the otolaryngology clinic complaining of a four-week history of odynophagia associated with a frequent urge to clear her throat. She had had a 35-pound weight loss over the previous 10 weeks, after the birth of triplets. She denied any fever, chills or shortness of breath. Another otolaryngologist had previously evaluated her and noted a lesion on her vocal fold. The patient had been treated with a trial of oral corticosteroids, which did not improve her symptoms. Her past medical history was otherwise notable for gastroesophageal reflux and the Caesarean section delivery of triplets. Her medications included acyclovir, omeprazole, aluminum hydroxide/magnesium hydroxide/simethicone and naproxen. She denied any tobacco or alcohol use and had not traveled outside the U.S. Videostroboscopy was notable for a left vocal fold papillomatous polyp near the anterior commissure, as well as diffuse nodular-appearing edema of the supraglottis and posterior commissure (Figure 1).
—Submitted by Jonathan B. Salinas, MD; Soroush Zaghi, MD; Gerald S. Berke, MD and Jennifer L. Long, MD, PhD, department of head and neck surgery, David Geffen School of Medicine, University of California, Los Angeles.