Sinonasal and laryngeal sarcoidosis

Abstract

Sarcoidosis is a chronic granulomatous inflammation of uncertain etiology that can involve any organ system in the body. Sinonasal and laryngeal involvement is rare, poorly understood, and difficult to diagnose. Additionally, the extent of the disease is variable, and the response to systemic corticosteroids is often poor. We report a case of a 55-year-old woman with prior cutaneous sarcoidosis who presented with chronic nasal congestion, difficulty breathing, dysphonia, and stridor, and biopsy of the nasal vestibule revealed noncaseating granulomatous inflammation.

Figure 1.

Cutaneous manifestations of sarcoidosis: (a) lupus pernio; (b) well-demarcated dark plaques with scarring on the patient's arm.

Figure 2.

CT of the neck revealing (a) thick nasal lining with obstructed nasal vestibules (arrow); (b) bilateral maxillary erosions (arrow); and (c) destruction of the premaxilla, palate, and floor of the nose and complete opacification of the left maxillary sinus (arrow).

Figure 3.

Nasal biopsy demonstrating a granuloma next to a hair follicle in the dermis, which has an extensive inflammatory infiltrate (hematoxylin and eosin, 200×).

Figure 4.

A bronchoscopic examination showing (a) erythema and edema of the supraglottis, including the arytenoids and false vocal cords or vestibular folds, and (b) a subglottic nodular lesion in the trachea.