Sinonasal sarcoidosis: a case report

Abstract

Sarcoidosis is an idiopathic and multisystemic chronic disease characterized by non-caseating granulomas. Sinonasal sarcoidosis may be seen in an isolated form or related to a multisystemic disease. A 48-year-old female patient visited the otolaryngology department with complaints of headache and nasal obstruction for two years. The physical examination revealed a saddling on the nose, and crusted fragile mucosa was observed bilaterally in nasal endoscopy. Paranasal CT showed invasion of the right orbita. In chest X-ray, there was bilateral hilar enlargement, and lung biopsy revealed non-caseating granulomas. A bilateral endoscopic sinus surgery was applied to the patient. Upon histopathological demonstration of multiple non-caseating granulomas in the specimen, the diagnosis of sinonasal sarcoidosis was made. The patient responded well to the following steroid treatment. Although rare, sarcoidosis should be taken into consideration in differential diagnosis of sinonasal diseases. 

Keywords

• sarcoidosis,sinonasal involvement,non-caseating granulomas

References

1. 1. Kirsten AM, Watz H, Kirsten D. Sarcoidosis with involvement of the paranasal sinuses - a retrospective analysis of 12 biopsy-proven cases. BMC Pulm Med 2013;13:59.
2. 2. Braun JJ, Gentine A and Pauli G. Sinonasal sarcoidosis: review and report of fifteen cases. Laryngoscope 2004;114:1960-3.
3. 3. Mazziotti S, Gaeta M, Blandino A, Vinci S, Pandolfo I. Perineural spread in a case of sinonasal sarcoidosis: case report. AJNR Am J Neuroradiol, 2001;22:1207-8.
4. 4. Erbek S, Erbek SS, Tosun E, Çakmak O. A rare case sarcoidosis involving the middle turbinates: an incidental diagnosis. Diagn Pathol 2006;1:44.
5. 5. Bianchini C, Tosin E, Ciorba A, Pelucchi S, Pastore A. Subcutaneoussarcoidosis: a rare involvement of the paralateral nasal region. Acta Otorhinolaryngol Ital 2011;31:118-20.
6. 6. Mekhail P, Abo-Khatwa M, El-Hawary A, Khan A. Cutaneous nasal nodule: a warning sign for sinonasal sarcoidosis. Internet J Head Neck Surg 2008;3(1).
7. 7. Mahfoudhi M, Khammassi K, Turki S, Salah MB. Systemic sarcoidosis revealed by a nasal lesion: a case report. Int J Clin Med 2015;6:257.
8. 8. James WE, Koutroumpakis E, Saha B, Nathani A, Saavedra L, Yucel RM, et al. Clinical features of extrapulmonary sarcoidosis without lung involvement. Chest 2018;154:349-56.

9. 9. Dessouky OY. Isolated sinonasal sarcoidosis with intracranial extension: case report. Acta Otorhinolaryngol Ital 2008;2:306-8.
10. 10. McCaffrey TV, McDonald TJ. Sarcoidosis of the nose and paranasal sinuses. Laryngoscope 1983;93:1281-4.
11. 11. Gulati S, Krossnes B, Olofsson J, Danielsen A. Sinonasal involvement in sarcoidosis: a report of seven cases and review of literature. Eur Arch Otorhinolaryngol 2012;269:891-6.
12. 12. Badhey AK, Kadakia S, Carrau RL, Iacob C, Khorsandi A. Sarcoidosis of the head and neck. Head Neck Pathol 2015;9:260-8.
13. 13. Helliwell TR. Non-infectious inflammatory lesions of the sinonasal tract. Head Neck Pathol 2016;10:32-9.
14. 14. McCaffrey TV. Nasal manifestations of systemic dieseases. Otolaryngol Pol 2009;63:228-35.
15. 15. Van den Boer C, Brutel G, de Vries N. Is routine histopathological examination of FESS material useful? Eur Arch Otorhinolaryngol 2010;267:381-4.