Question:  A 42 year old female is referred to you for chronic oral ulcerations, hoarseness, and occasional dyspnea.  Upper nasopharyngoscopy reveals pharyngeal ulcerations with a fibrotic appearance.  Tracheoscopy reveals subglottic stenosis extending superiorly to limit the motion of the right true vocal fold.  She brings with her laboratory reports that show no abnormalities in ANCA or PR3.  She has no anogenital involvement.  What is your presumptive diagnosis?  [Answer will be posted with next week's new question]

Answer to last week's question, "Bloodsuckers" (June 20, 2016): 

Medicinal leeches secrete hirudin, which is the most potent natural inhibitor of thrombin.