Disclaimer: The information contained within the Grand Rounds Archive is intended for use by doctors and other health care professionals. These documents were prepared by resident physicians for presentation and discussion at a conference held at Baylor College of Medicine in Houston, Texas. No guarantees are made with respect to accuracy or timeliness of this material. This material should not be used as a basis for treatment decisions, and is not a substitute for professional consultation and/or peer-reviewed medical literature.Sarcoidosis Case Presentation: S.B. is a 42-year-old black female who was initially told in 1991 that she had sarcoidosis of the nose and pharynx after biopsies were taken during sinus surgery for chronic sinusitis. She was treated with steroids for a few months and then stopped treatment. She developed chronic drainage from her left ear in 1993 and continued to have chronic sinusitis. She then developed a left facial rash in 1994, which continued to enlarge. She presented to the otolaryngology service in February 1995 complaining of hoarseness and shortness of breath with exertion for the past 3 months. She also complained of difficulty breathing through her nose. Flexible laryngoscopy revealed a significant nasopharyngeal stenosis, as well as an extremely thickened epiglottis. Laboratory tests revealed an ESR of 57, an ANA titer of 1:40, and an ACE level of 56. The patient was taken to the operating room where an awake tracheotomy and direct laryngoscopy with biopsies was performed. Laryngoscopy revealed edema and marked thickening of an omega shaped epiglottis. The glottic inlet was unable to be visualized. Biopsies were taken of the epiglottis as well as the left facial lesion. Pathology of both specimens showed noncaseating granulomas consistent with sarcoidosis. Special stains for AFB and fungus were negative. Further work-up revealed a newly positive PPD and a CXR with fibrolinear scarring in the left upper lobe. Consultation with the Rheumatology, Pulmonary, and Dermatology services agreed with the diagnosis of sarcoidosis and the patient was started on prednisone. However, because of the patient's newly positive PPD and CXR findings, she was also started on four drug therapy for tuberculosis. Her sputum cultures were negative for Mycobacterium tuberculosis, but her skin biopsy cultures were positive for tuberculosis. She completed her TB therapy. Her facial lesion improved significantly with steroids, but the patient remained tracheotomy dependent. Her steroids were tapered slowly over the next year. She is currently without pulmonary symptoms of sarcoidosis. Benjamin B, Dalton C, Croxson G. Laryngoscopic diagnosis of laryngeal sarcoid. Ann Oto Rhinol Laryngol 1995;104;529-531. Binder D, Yahatom R, Taicher S. Oral manifestations of sarcoidosis. Oral Surg Oral Med Oral Pathol Oral Radiol Endod 1997;83:458-461. Dash GI, Kimmelman CP. Head and neck manifestations of sarcoidosis. Laryngoscope 1988;98:50-53. DeRemee RA. Sarcoidosis. Mayo Clin Proc 1995;70:177-181. Ellison DE, Canalis RF. Sarcoidosis of the head and neck. Clin Dermatol 1986;4:136-142. Fortune S, Courey MS. Isolated laryngeal sarcoidosis. Otolaryngol Head Neck Surg 1998;118:868-870. Frable MAS, Frable WJ. Fine-needle aspiration biopsy: Efficacy in the diagnosis of head and neck sarcoidosis. Laryngoscope 1984;94:1281-1283. Hooper R, Holden H. Acoustic and vestibular problems in sarcoidosis. Arch Otolaryngol Jahrsdoerfer RA, Johns MME, Thompson EG, Cantrell RW. Sarcoidosis and fluctuating hearing loss. Ann Otolo 1981;90:161-163. Josephson GD, Winicki RE. Laryngeal sarcoidosis. Otolaryngol Head Neck Surg 1999;120:134-135. Kataria YP, Holter JF. Immunology of sarcoidosis. Clin Chest Med 1997;18:719-739. Kimani AP, Aguayo SM. Sarcoidosis: An overview for the primary care physician. Comp Ther 1998;24:1120-1125. Krespi YP, Husain S, Mitrani M, Meltzer CJ. Treatment of laryngeal sarcoidosis with intralesional steroid injection. Ann Otol Rhinol Laryngol 1987;96:713-715. Krespi YP, Kuriloff DB, Aner M. Sarcoidosis of the sinonasal tract: A new staging system. Otolaryngol Head Neck Surg 1995;112:221-227. Lazarus A. Sarcoidosis. Otolaryngol Clin North Am 1982;15:621-633. Lynch JP. Pulmonary sarcoidosis: Current concepts and controversies. Comprehen Ther 1997;23:197-210. Lynch JP, Kazerooni EA, Gay SE. Pulmonary sarcoidosis. Clin Chest Med 1997;18:755-785. Mana J, Marcoval J, Graells J, Salazar A, Peyri J, Pujol R. Cutaneous involvement in sarcoidosis: Relationship to systemic disease. Arch Dermatol 1997;133:882-888. Miglets AW, Viall JH, Kataria YP. Sarcoidosis of the head and neck. Laryngoscope 1977;87:2038-2048.Muller-Quernheim J. Sarcoidosis: Clinical manifestations, staging and therapy (part II). Respir Med 1998;92:140-149. Neel HB, McDonald TJ. Laryngeal sarcoidosis: Report of 13 patients. Ann Otol Rhinol Laryngol 1982;91:359-362. Newman LS, rose CS, Maier LA. Sarcoidosis. New Engl J Med 1997;336:1224-1234. Shah UK, White JA, Gooey JE, Hybels RL. Otolaryngolgic manifestations of sarcoidosis: Presentation and diagnosis. Laryngoscope 1997;107:67-75. Weisman RA, Canalis RF, Powell WJ. Laryngeal sarcoidosis with airway obstruction. Ann Otol 1980;89:58-61. Zissel G, Muller-Quernheim J. Sarcoidosis: Historical perspective and immunopathogenesis (part I). Respir Med 1998;92:126-139. Click here to view slides from this presentation (pdf file): Grand Rounds Archive | Department Home page BCM Public | BCM Intranet | Privacy Notices | Contact BCM | BCM Site Map | ©2001-2005 Baylor College of Medicine
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