Sinonasal involvement in sarcoidosis: a case-control study of 20 patients.
We conducted a retrospective single-center study to describe the clinical features of sinonasal sarcoidosis (SNS) and to determine whether SNS is associated with a particular clinical phenotype of sarcoidosis. Twenty patients with histologically proven SNS (men/women, 7/13; mean age, 32 +/- 9 yr) were compared with control patients with sarcoid but without sinonasal (SN) involvement. Each patient was matched with 2 controls for the date of admittance in our institution. SN involvement occurred in the course of previously known sarcoidosis in 8 patients, whereas it preceded disease diagnosis in 12 patients. Among these 12 patients, 4 initially presented with strictly isolated SNS and 8 had other associated signs related to sarcoidosis. The most common symptoms were stuffiness (90%), anosmia (70%), and rhinorrhea (70%). Lupus pernio was frequent (50%). Local examination was constantly abnormal and showed hypertrophy (75%) and purplish coloring of the nasal mucosa with granulations (50%) on the septum and/or inferior turbinates. Computed tomography scans showed medial lytic lesions, mainly of the septum and/or the turbinates in about half the cases. All patients had negative antineutrophil cytoplasmic antibodies. Patients with SNS had significantly more frequent and severe involvement of vital organs than controls, had a longer history of sarcoidosis, and required systemic treatment more frequently (100% vs. 57.7%, p < 0.001) and for a longer time (78 +/- 42 mo vs. 29 +/- 18 mo, p < 0.0001). Corticosteroids maintenance dosage was high (10.5 +/- 6 mg daily) and mainly depended on SN involvement. Although rare, SN involvement is a severe and recalcitrant manifestation of sarcoidosis representing a therapeutic challenge.
Aubart
Fleur Cohen
FC
From Universitë Paris 13, UPRES EA 2363, Services de Pneumologie (FCA, DV, HN), ORL (MO), Radiologie (MB, PA), and Anatomopathologie (MK), Höpital Universitaire Avicenne, Assistance Publique-Höpitaux de Paris, Bobigny, France.
Ouayoun
Michel
M
Brauner
Michel
M
Attali
Patrick
P
Kambouchner
Marianne
M
Valeyre
Dominique
D
Nunes
Hilario
H
D000328:Adult; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D010254:Paranasal Sinus Diseases / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000175:diagnosis / Q000473:pathology* / Q000601:surgery; D014057:Tomography, X-Ray Computed