Sinonasal disease in patients with sarcoidosis

Sarcoidosis is a chronic granulomatous disease of unclear etiology with a p ropensity to involve the lower respiratory tract, but may also involve the upper respiratory tract. Histologically, it is characterized by non-caseati ng granulomas of various organ systems. Although nasal and sinus involvemen t is uncommon, patients with sarcoidosis presenting with nasal and sinus co mplaints may have sinonasal sarcoidosis or simply rhinosinusitis. We review ed the cases of six patients with pulmonary sarcoidosis who developed chron ic sinonasal disease. All six patients had intranasal findings consistent w ith sinonasal sarcoidosis, but only four had histologic evidence of sinonas al sarcoidosis. These four patients continue to require extensive therapy i ncluding topical steroids, systemic steroids, intralesional steroid injecti ons, and nasal irrigations. We conclude that patients with histologically p roven sinonasal sarcoidosis present a significant therapeutic challenge bec ause their symptoms and physical findings are often persistent despite aggr essive medical and surgical therapy. Their recalcitrant sinonasal disease i s thought to result from the destruction of cilia and mucus-producing gland s by the granulomatous process.