TY - JOUR T1 - Severe Vocal Cord Dysfunction: An Unusual Complication of Juvenile Dermatomyositis JF - The Journal of Rheumatology JO - J Rheumatol SP - 744 LP - 745 DO - 10.3899/jrheum.121338 VL - 40 IS - 5 AU - HOSAM O. ALTHAGAFI AU - KIMBERLY MORISHITA AU - ROSS E. PETTY Y1 - 2013/05/01 UR - http://www.jrheum.org/content/40/5/744.abstract N2 - To the Editor:Juvenile dermatomyositis (JDM) is a rare childhood disease characterized by varying degrees of skin and muscle inflammation. Other organ systems, including the gastrointestinal, pulmonary, cardiovascular, articular, ophthalmologic, and nervous systems, can be involved1. Pharyngeal, hypopharyngeal, and palatal muscles are frequently affected, leading to dysphagia and dysphonia1,2. To our knowledge, severe vocal cord dysfunction due to laryngeal muscle involvement has not been reported to date.We describe a 15-year-old boy of Kurdish background who presented with a 6-month history of dryness, scaling, and fissuring to his palms and soles, which was initially diagnosed as palmoplantar keratoderma. Laboratory screening before he started oral retinoid therapy revealed elevated aspartate aminotransferase (AST) of 198 U/l (normal 10–45), alanine aminotransferase (ALT) 287 U/l (normal 10–40), and lactate dehydrogenase (LDH) 1133 U/l (normal 360–730). Subsequent investigations showed antinuclear antibody titer of 1:640 for speckled pattern and 1:1280 nucleolar pattern, and the presence of anti PM-Scl antibodies. Over the subsequent 3 weeks, his rash progressed to involve the distal forearms and legs, and a new scaly … Address correspondence to Dr. H.O. Althagafi; E-mail: hosamthagafi{at}yahoo.com ER -