General Clinical Manifestations
Intrathoracic manifestations of sarcoidosis include pulmonary infiltrates and hilar lymphadenopathy, as well as cardiac sarcoidosis (more common in older Japanese females), which can be life-threatening (1, 7). Extrathoracic disease occurs in around 50% of patients, and virtually every organ can be affected (1). The extent and degree of disease is extremely variable between patients. Skin, lymph node, eye and liver involvement are most common outside of the thorax, each being found in between 10-25% of patients (1).
Around 10-15% of patients with sarcoid have ENT manifestations of sarcoidosis (1, 5, 9) which may be the presenting symptom of their disease (10). The differential often includes vasculitides such as granulomatosis with polyangiitis, formerly called Wegener’s, or eosinophilic granulomatosis with polyangiitis, formerly Churg-Strauss syndrome, granulomas of infective origin (such as tuberculosis, aspergillosis, or actinomycosis), and inflammatory diseases with extrasystemic manifestations, such as Crohn’s disease, which should be excluded (4). Sinonasal sarcoidosis is rare (occurring in 1-4% of patients), but has been described in numerous case studies, and is a well-recognised chronic and stubborn form of the disease (8, 10, 11). Sarcoidosis can also involve the larynx, salivary glands and ear in rare cases (3, 12-16).