title: Sinonasal involvement in sarcoidosis: a case-control study of 20 patients.
abstract: 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.
authors.affiliation: 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.
authors.forename: Fleur Cohen
authors.initials: FC
authors.lastname: Aubart
authors.forename: Michel
authors.initials: M
authors.lastname: Ouayoun
authors.forename: Michel
authors.initials: M
authors.lastname: Brauner
authors.forename: Patrick
authors.initials: P
authors.lastname: Attali
authors.forename: Marianne
authors.initials: M
authors.lastname: Kambouchner
authors.forename: Dominique
authors.initials: D
authors.lastname: Valeyre
authors.forename: Hilario
authors.initials: H
authors.lastname: Nunes
mesh_terms: 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