The forgotten cause of sicca complex; sarcoidosis

Sarcoidosis is a chronic systemic disease of unknown cause with prominent symptoms from the respiratory system. It can occasionally affect the exocrine glands presenting with xerophthalmia and xerostomia similar to Sjögren's syndrome. We present 5 such patients who visited our rheumatology clinic complaining of dry eyes and mouth. Investigation for xerophthalmia and xerostomia showed positive rose bengal tests in all patients, positive Schirmer's I tests in 4 and decreased parotid flow rate in 3. Minor salivary gland biopsy showed noncaseating granulomas compatible with sarcoidosis in 3. In the other 2 patients the diagnosis was obtained with transbronchial lung biopsy that revealed noncaseating granulomas. Transbronchial lung biopsy also showed granulomas in 2 patients with positive minor salivary gland biopsy. Our results suggest that sarcoidosis can present with initial symptoms of dry eyes and dry mouth. When this happens, transbronchial and minor salivary gland biopsy are very valuable in differentiating sarcoidosis from Sjögren's syndrome.