A Sarcoidosis ofthe UpperRespiratory Tract

Although sarcoidosis of the upper respiratory tract (SURT) is generally considered to be uncommon, SURT occurs more frequently than generally realized, and it can have most persistent and disabling manifestations.¹ The lesions due to SURT involve the nose (69%), sinuses (50–64%), tonsils (36%), larynx, (1–5%), and

tongue (rare).^3–14To establish the diagnosis,^2–10,13,14histo- logical confirmation of the disease is necessary, along with an assessment of the extent and severity of the disease, an assessment of whether the disease is stable or likely to progress, and a determination of the therapy’s benefit is needed.

107

CHAPTER 19

Sarcoidosis of the Upper Respiratory Tract

FIGURE 19.1 A chest X-ray with bilateral hilar lymph nodes enlargement. The diagnosis of pulmonary sarcoidosis was estab- lished in 1999. The patient was treated with corticosteroids. During follow-up visits, he complained of nasal crusting and dryness. His angiotensin converting enzyme (ACE) was high. Biopsy specimen from the nasal mucosa showed granulomatous inflammation.

FIGURE 19.2 Although the lesions resemble the herpes simplex crusts on the nasal mucosa, the biopsy showed noncaseating granulomas.

108 Atlas of Sarcoidosis

Chest X-ray findings, which are the first line of inves- tigation in diagnosing sarcoidosis, are abnormal in more than 90% of patients.

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FIGURE 19.3 A 58-year-old female patient with chronic sar- coidosis involving lungs, bones, and nails. The biopsy specimen confirmed the diagnosis of the nasal mucosa sarcoidosis. She is under the treatment with methotrexate. Her response to steroids was poor, and she did not tolerate the side effects of the prednisolone.

FIGURE 19.4 Much improved, the same patient shown in Figure 19.3 is still receiving methotrexate.