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Sarcoidosis of the paranasal sinuses. Eur Arch Otorhinolaryngol 2019; 276:1969-1974. [PMID: 30900021 DOI: 10.1007/s00405-019-05388-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2019] [Accepted: 03/12/2019] [Indexed: 12/26/2022]
Abstract
BACKGROUND Sarcoidosis is a chronic disease, which predominantly affects the lung. Since sinonasal sarcoidosis is rare, little is known about the sarcoidosis manifestation at this site. Therefore, the aim of our study was to detect the prevalence of sinonasal sarcoidosis, its clinical occurrence, diagnosis, and therapy. METHODS The database of all patients having visited the otorhinolaryngology departments of the universities in Göttingen and in Bonn between 2003 and 2016 was searched for the diagnosis of sinonasal sarcoidosis. RESULTS Thirteen patients with a biopsy-proven sinonasal sarcoidosis were identified. Most patients presented non-specific clinical symptoms, which are also found in acute and chronic sinusitis. None of the patients was suspected to have sinonasal sarcoidosis by the ENT doctor before histological validation. The mean diagnostic delay was 262 (± 195) days. An additional pulmonary involvement was detected in four of six patients. CONCLUSIONS Sinonasal sarcoidosis is presenting with heterogeneous clinical presentations. An early biopsy of granulomatous lesions is mandatory. A multidisciplinary approach is needed to exclude serious lung or heart manifestations, because even asymptomatic organ involvement is possible. A CT-scan may be useful even if unspecific. Local or systemic therapy has to be prepared individually using local and systemic corticosteroids, antimetabolites, or anti-TNF-alpha.
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Abstract
The aim of this study was to define a role for endoscopic sinus surgery (ESS) in the treatment of chronic sinonasal sarcoidosis. All patients seen for sinonasal sarcoidosis in an otolaryngology practice in a tertiary care center from 1991 to 2000 were reviewed. Of 86 patients, 6 were treated with ESS for an operative rate of 7%. Surgeries were performed on those patients with significant sinonasal anatomic blockage. This included nasal obstruction from nasal polyposis and chronic and recurrent acute sinusitis from granulomatous lesions of the ostiomeatal complex. Patients remained symptom free for years after surgery on a nasal steroid regimen. Endoscopic sinus surgery is a viable treatment for those few patients with nasal obstruction or chronic sinusitis due to anatomic blockage from sinonasal sarcoidosis. Although it does not eradicate the disease or prevent recurrence, it does markedly improve quality of life by relieving severe symptoms and reducing the need for systemic steroids. This is the first study to advocate a role for surgery in sinonasal sarcoidosis beyond biopsy and management of complications. Although it may not be the appropriate approach for every patient, ESS certainly should be considered in the treatment options.
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Affiliation(s)
- David J. Kay
- Department of Otolaryngology, State University of New York Health Science Center at Brooklyn and the Long Island College Hospital, Brooklyn, New York
| | - Gady Har-El
- Department of Otolaryngology, State University of New York Health Science Center at Brooklyn and the Long Island College Hospital, Brooklyn, New York
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Cho KH, Shin JH, Park SH, Kim HS, Yang SH. A case of pulmonary sarcoidosis with endobronchial nodular involvement. Tuberc Respir Dis (Seoul) 2013; 74:274-9. [PMID: 23814600 PMCID: PMC3695310 DOI: 10.4046/trd.2013.74.6.274] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2012] [Revised: 09/24/2012] [Accepted: 10/23/2012] [Indexed: 11/24/2022] Open
Abstract
Sarcoidosis is a multisystemic disorder of unknown cause that is characterized pathologically by noncaseating granulomas. Diagnosis is based on the exclusion of other infectious, interstitial, and neoplastic diseases and on the typical pathology. Although the lungs and mediastinal lymph nodes are almost involved, endobronchial nodular lesions of sarcoidosis with lung involvements are rare. We report a case of sarcoidosis with lung involvements and endobronchial nodules as confirmed by bronchial biopsy.
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Affiliation(s)
- Kyung Hwa Cho
- Department of Internal Medicine, Wonkwang University College of Medicine, Iksan, Korea
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Reed J, deShazo RD, Houle TT, Stringer S, Wright L, Moak JS. Clinical features of sarcoid rhinosinusitis. Am J Med 2010; 123:856-62. [PMID: 20800155 DOI: 10.1016/j.amjmed.2010.05.012] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2009] [Revised: 04/06/2010] [Accepted: 05/02/2010] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We asked if certain clinical features were useful predictors of sarcoid rhinosinusitis in general populations of patients with chronic rhinosinusitis. METHODS Our patients with sarcoid rhinosinusitis and those from the literature formed the study group. A group of 21 randomly selected patients from The University of Mississippi Medical Center Allergy Clinic with chronic rhinosinusitis composed the control group. RESULTS Our literature search identified 73 patients with sarcoid rhinosinusitis reported since 1999. Twenty patients met inclusion criteria and were added to 16 of our patients to compose the study group of 36 patients. The majority of the study group was African-American (61%) and female (69%) and had pulmonary sarcoidosis (67%) and other forms of extrapulmonary sarcoidosis in addition to sarcoid rhinosinusitis (86%). The 5 most common upper respiratory signs/symptoms were nasal obstruction (86%), nasal crusting (47%), anosmia (44%), epistaxis (28%), and nasal polyposis (25%). Odds ratios for sarcoid rhinosinusitis were 2.5 for persistent nasal obstruction, 7.7 for epistaxis, 16.0 for anosmia, and 18.8 for nasal crusting. For each symptom, the odds of sarcoid rhinosinusitis increased by 9.4 (95% confidence interval, 1.8-49.9). Nasal crusting was associated with the coexistence of atrophic rhinosinusitis at nasal endoscopy. Treatment with oral corticosteroids and other immunosuppressive therapy, primarily methotrexate, was frequently required. CONCLUSION The coexistence of chronic rhinosinusitis and 2 of the signs of nasal crusting, anosmia, or epistaxis are highly specific for sarcoid rhinosinusitis. Even in the absence of an established diagnosis of sarcoidosis, sinonasal biopsy should be considered for diagnosing these patients with chronic rhinosinusitis.
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Affiliation(s)
- Jo Reed
- Department of Medicine, The University of Mississippi Medical Center, Jackson, MS, USA
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Chae DR, Lim SU, Cho GJ, Lim JH, Ju JY, Kwon YS, Oh IJ, Kim KS, Kim YI, Lim SC, Kim YC. Sarcoidosis Initially Presenting as a Nasal Cavity Mass Misdiagnosed as Tuberculosis. Tuberc Respir Dis (Seoul) 2008. [DOI: 10.4046/trd.2008.65.2.121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Dong Ryeol Chae
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Seong Uk Lim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Gye Jung Cho
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jung Hwan Lim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Jin Yung Ju
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yong Soo Kwon
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - In Jae Oh
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Kyu Sik Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Yu Il Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Sung Chul Lim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
| | - Young Chul Kim
- Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea
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Hübsch G, Barre P, Solans T, Merol JC, Jaussaud R, Labrousse M, Chays A. [Sinuso-nasal sarcoidosis]. ACTA ACUST UNITED AC 2006; 122:281-6. [PMID: 16505778 DOI: 10.1016/s0003-438x(05)82362-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
OBJECTIVES Sinonasal sarcoidosis is unusual and may be misdiagnosed. We describe the characteristic clinical presentation observed in three patients treated in our institution and define the complementary explorations leading to diagnosis. Basis for treatment is also developed. PATIENTS AND METHODS Among one hundred and one patients treated for sarcoidosis between 1983 and 2003 in three department of RD Hospital, three had histologically proved sinonasal sarcoidosis. These three cases were retrospectively analyzed and compared with the literature. RESULTS All patients complained of chronic rhinosinusitis without improvement under usual treatment. Computed tomography showed usual aspects of chronic rhinosinusitis. The diagnosis was finally based on the biopsy of the nasal mucosa. Even if sarcoidosis had been already diagnosed, the main point was the delay between ENT symptoms and diagnosis because all clinical presentations and radiological aspects were aspecific. CONCLUSION This case report underlines the difficulty to diagnose sinonasal sarcoidosis. When a patient is treated for sarcoidosis, sinonasal localization of the disease must be suggested in the event of chronic rhinosinusitis. On the other hand, sarcoidosis must be suggested and specific complementary examination must be performed in the event of chronic rhinosinusitis without improvement under usual treatment. ENT biopsy remains the main argument for diagnosis.
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Affiliation(s)
- G Hübsch
- Service d'ORL, Hôpital Robert Debré, avenue du général Koenig, 51100 Reims
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Long CM, Smith TL, Loehrl TA, Komorowski RA, Toohill RJ. Sinonasal disease in patients with sarcoidosis. AMERICAN JOURNAL OF RHINOLOGY 2001; 15:211-5. [PMID: 11453511 DOI: 10.2500/105065801779954157] [Citation(s) in RCA: 30] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
Sarcoidosis is a chronic granulomatous disease of unclear etiology with a propensity to involve the lower respiratory tract, but may also involve the upper respiratory tract. Histologically, it is characterized by non-caseating granulomas of various organ systems. Although nasal and sinus involvement is uncommon, patients with sarcoidosis presenting with nasal and sinus complaints may have sinonasal sarcoidosis or simply rhinosinusitis. We reviewed the cases of six patients with pulmonary sarcoidosis who developed chronic sinonasal disease. All six patients had intranasal findings consistent with sinonasal sarcoidosis, but only four had histologic evidence of sinonasal sarcoidosis. These four patients continue to require extensive therapy including topical steroids, systemic steroids, intralesional steroid injections, and nasal irrigations. We conclude that patients with histologically proven sinonasal sarcoidosis present a significant therapeutic challenge because their symptoms and physical findings are often persistent despite aggressive medical and surgical therapy. Their recalcitrant sinonasal disease is thought to result from the destruction of cilia and mucus-producing glands by the granulomatous process.
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Affiliation(s)
- C M Long
- Department of Otolaryngology and Communication Sciences, The Medical College of Wisconsin, Milwaukee 53226-9796, USA
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Affiliation(s)
- D G Colden
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA 02114, USA
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Lindeboom JA, van den Akker HP. Sinusitis as the first indication of sarcoidosis an incidental finding in a patient with presumed 'odontogenic' sinusitis: case report. Br J Oral Maxillofac Surg 2000; 38:277-9. [PMID: 10922150 DOI: 10.1054/bjom.1999.0229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Involvement of the paranasal sinuses and nose by sarcoidosis is uncommon, and has been reported in only 1-4% of patients with sarcoidosis. Clinical symptoms are nasal obstruction, epistaxis, nasal pain, discharge, anosmia or hyposmia, epiphora, and dyspnoea. We present a case of sarcoidosis in which sinusitis was the first clinical sign of the disease.
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Affiliation(s)
- J A Lindeboom
- Department of Oral and Maxillofacial Surgery, Academic Medical Center and Academic Center for Dentistry (ACTA), University of Amsterdam, Amsterdam, The Netherlands.
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deShazo RD, O'Brien MM, Justice WK, Pitcock J. Diagnostic criteria for sarcoidosis of the sinuses. J Allergy Clin Immunol 1999; 103:789-95. [PMID: 10329811 DOI: 10.1016/s0091-6749(99)70421-5] [Citation(s) in RCA: 39] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
BACKGROUND Although newer technologies facilitate its diagnosis and treatment, little is known about sarcoidosis of the paranasal sinuses. OBJECTIVES We sought to better characterize sarcoidosis of the sinuses and establish criteria for diagnosis. METHODS Case-finding criteria were established, and over 50 reports of sarcoidosis of the sinuses in the medical literature were reviewed. Nine case reports of patients fulfilling the case-finding criteria were identified, as were 6 additional patients from our clinics. RESULTS Nasal obstruction and chronic sinusitis were the usual initial complaints from patients and were associated with mucosal crusting, studding, plaque-like changes, or polyps in the nose in 5 of 6 of our patients. The most consistent finding in nose and sinuses was an erythematous, edematous, friable, hypertrophied mucosa. Like 5 of 6 of our patients, most patients had extra-pulmonary sarcoidosis involving multiple organs, but some had isolated upper respiratory disease. Radiologic studies showed extensive and often complete opacification of the sinuses and nose similar to that seen in diffuse polyposis associated with chronic bacterial and fungal sinusitis. No specific histopathologic findings distinguished sinus disease from those reported with pulmonary involvement. Pharyngeal involvement was present in 2 case reports and caused the apparent asphyxiation of 1 of our patients. CONCLUSION Sarcoidosis of the sinuses should be considered in the differential diagnosis of sinusitis, especially in association with nasal polyposis, even when the sarcoidosis has not been otherwise diagnosed. On the basis of this experience, we propose diagnostic criteria for sarcoidosis of the sinuses. These include (1) radiologic evidence of sinusitis, (2) histopathologic confirmation of noncaseating granuloma in the sinus tissue supported by negative stains for fungus and acid-fast bacilli, (3) negative serologic test results for syphilis and antineutrophil cytoplasmic antibodies, and (4) no clinical evidence of other disease processes associated with granulomatous nasal and sinus inflammation. These criteria will provide the basis for further studies to assess both the natural history and the effectiveness of treatment in sarcoidosis of the sinuses.
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Affiliation(s)
- R D deShazo
- Division of Allergy and Clinical Immunology, School of Medicine, University of Mississippi Medical Center, Jackson, MS, USA
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Hassid S, Choufani G, Saussez S, Dubois M, Salmon I, Soupart A. Sarcoidosis of the paranasal sinuses treated with hydroxychloroquine. Postgrad Med J 1998; 74:172-4. [PMID: 9640446 PMCID: PMC2360822 DOI: 10.1136/pgmj.74.869.172] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
A case of sarcoidosis of the paranasal sinuses is reported. Biopsies of the sinus mucosa showed typical noncaseating granulomas. Hydroxychloroquine, which is known to be active on the cutaneous form of sarcoidosis, was used here with success and is proposed as an effective alternative to high-dose systemic steroids.
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Livas I, Essayan DM. A 54-year-old woman with rhinitis and a right ethmoid sinus mass. Ann Allergy Asthma Immunol 1996; 76:405-10. [PMID: 8630711 DOI: 10.1016/s1081-1206(10)63454-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- I Livas
- Division of Allergy and Clinical Immunology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
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