SARCOIDOSIS OF THE PARANASAL SINUSES CAUS ING THERAPY-RESISTANT DACRYOCYSTITIS - CASE-REPORT

Background: Sarcoidosis is a chronic systemic disease of unknown etiol ogy characterized by non-caseating granulomatous inflammation of vario us organs. The clinical findings when nasal mucosa is involved include nasal crusting, epistaxis, pain and/or anosmia, nasal polyps, or subm ucosal nodularity. Case report: We describe a case of sarcoidosis of t he paranasal sinuses. In a 33-year-old man, the first symptom was ther apy resistant putrid dacryocystitis. Further there had been symptoms o f chronic sinusitis. A CT scan revealed swelling of the mucosa in the anterior ethmoid, frontal recess, and maxillary sinus. As the disease obviously affected the region of the nasolacrimal duct with consecutiv e stenosis of this canal, we opted for endoscopic sinus surgery. A few days after this endoscopic procedure, the dacryocystitis had healed. Results: The histopathological examination showed the typical picture of sarcoidosis that had its primary manifestation in the paranasal sin uses. According to these findings further explanation of the patient w as necessary. The diagnosis of sarcoidosis was confirmed by lavage,and biopsy material of bronchoscopically suspect lung areas. Consequently , the patient underwent a long-term corticoid therapy and today, 10 mo nths after the surgical intervention, the patient is free of symptoms. Follow-up endoscopy of the paranasal sinuses showed no further pathol ogical findings. Conclusion: Our case demonstrates that the first mani festation of sarcoidosis can be in the paranasal sinuses.