Ear, Nose, and Throat sarcoidosis: An etiology that should raise a flag? About two case reports

Sarcoidosis is a chronic inflammatory disease characterized by non-caseous necrotizing epithelial cell granulomas that can affect any organ. Ear, nose, and throat (ENT) involvement is rare. We report two cases of systemic sarcoidosis with ENT onset.

A 39-year-old woman with no medical history, presented with right submaxillary lymphadenopathy, associated with a nasopharyngeal swelling on the nasopharyngoscopy. Lymph node biopsy revealed numerous granulomas with epithelioid and giant cells. The computed tomography (CT) showed multiple lymph nodes along with interstitial lung disease. The diagnosis of sarcoidosis with pulmonary, mediastinal, lymph node, and nasopharyngeal involvement was retained and the patient was treated with glucocorticoids with disappearance of the submaxillary swelling and of the lymph nodes on the CT. Another 39-year-old woman, with no medical history, presented to the ENT clinic with a three-month history of bilateral nasal obstruction. Nasal endoscopy revealed hyperemia of the nasal mucosa. She was treated with antibiotics without clinical improvement. CT scan of the cranial and facial bones revealed a focal bulge at the nasopharynx's posterior wall, associated with a mucosal thickening of maxillary, frontal, and ethmoid sinuses. A nasal and a lymph node biopsy were then performed, revealing granulomatous inflammation without caseous necrosis. The diagnosis of sarcoidosis with pulmonary, lymph node, and sinonasal involvement was established. The patient was treated with glucocorticoids with clinical improvement.

Nasopharyngeal and sinus involvement may be rare in sarcoidosis but can be part of the initial clinical picture of the disease. Therefore, it should put the flea in the ear in case of ENT granulomatosis.