Systemic lupus erythematosus (SLE) is a chronic, multifaceted
inflammatory disease that can affect every organ system of the
body. SLE is variable in its manifestations and follows a remitting
and relapsing course. This disease involves multisystem microvascular
inflammation caused by autoantibodies. Nasal septal
pathology is an uncommon feature of SLE, with perforation
as the most common septal manifestation, and generally
occurs during exacerbations and in a context of systemic vasculitis.
There are reports of septal perforation being the presenting
symptom of SLE. Lesions are typically asymptomatic
and patients are many times not aware of their nasal problem.
A theory of the pathogenesis of perforation is that the defect
begins with ischemia, causing a nasal mucosal ulceration with
subsequent chondrolysis. Another theory of vasculitis is as
an important etiologic feature in perforation. However, no histological
evidence of vasculitis has been documented in the nasal
mucosa of SLE patients with nasal septum perforation.
Prior to any therapy for the septal pathology, the underlying
rheumatologic process needs to be treated.
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