Original Article

Clinical Manifestations, Radiographic Findings, Treatment Options, and Outcome in Sarcoidosis Patients with Upper Respiratory Tract Involvement

Authors: Efstratios Panselinas, MD, Lucinda Halstead, MD, Rodney J. Schlosser, MD, Marc A. Judson, MD

Abstract

Background: Sarcoidosis of the upper respiratory tract (SURT) is an underappreciated manifestation of sarcoidosis. We described the clinicoradiological findings, methods of treatment, and outcomes of 68 patients with SURT seen in our clinic over a 7-year period.


Methods: This was a retrospective study. A Case Control Etiology of Sarcoidosis Study (ACCESS) instrument of organ involvement was used to classify patients with SURT. Patients with a definite or probable diagnosis of SURT underwent chart review for symptoms, radiological features, treatment, and outcome.


Results: There were 6.8% (68/998) of patients in the sarcoidosis clinic who had SURT. The most common presenting symptom was nasal congestion (61%, 34/56). In patients who had SURT diagnosed after the initial presentation of sarcoidosis, the mean prednisone dose more than quadrupled (4 ± 6.5 vs 18.6 ± 15.9, P = 0.002) between the diagnosis of SURT and the end of follow up. By the end of follow up, only 40% of our cohort had significant improvement of SURT.


Conclusion: SURT is a form of sarcoidosis that is not uncommon. Relatively high doses of corticosteroids are required to control the disease, and improvement occurs in a minority of the patients although the disease usually can be stabilized. Surgery should be reserved for life-threatening complications as surgical outcomes are relatively poor.


Key Points


* Upper airway involvement is not uncommon in sarcoidosis.


* Patients are usually present with nonspecific symptoms, as well as endoscopic and radiologic findings that make the differential diagnosis more problematic than more common diagnoses.


* Relatively high doses of corticosteroids are required to control the disease.


* Surgery should be reserved for life-threatening complications as surgical outcomes are relatively poor.

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