Les localisations naso-sinusiennes de la sarcoïdose

Abstract

Sinonasal sarcoidosis is unusual and may be misdiagnosed. We describe the characteristic clinical presentation observed in three patients treated in our institution and define the complementary explorations leading to diagnosis. Basis for treatment is also developed. Among one hundred and one patients treated for sarcoidosis between 1983 and 2003 in three department of RD Hospital, three had histologically proved sinonasal sarcoidosis. These three cases were retrospectively analyzed and compared with the literature. All patients complained of chronic rhinosinusitis without improvement under usual treatment. Computed tomography showed usual aspects of chronic rhinosinusitis. The diagnosis was finally based on the biopsy of the nasal mucosa. Even if sarcoidosis had been already diagnosed, the main point was the delay between ENT symptoms and diagnosis because all clinical presentations and radiological aspects were aspecific. This case report underlines the difficulty to diagnose sinonasal sarcoidosis. When a patient is treated for sarcoidosis, sinonasal localization of the disease must be suggested in the event of chronic rhinosinusitis. On the other hand, sarcoidosis must be suggested and specific complementary examination must be performed in the event of chronic rhinosinusitis without improvement under usual treatment. ENT biopsy remains the main argument for diagnosis.