Systemic sarcoidosis presenting with Horner's syndrome and mandibular paresthesia

A patient with Stage I systemic sarcoid (affecting the mediastinum and cervical lymph nodes) is presented. This patient had ptosis of the eyelid and miosis (Horner's syndrome) due to involvement of the cervical-thoracic sympathetic nerves by the granulomatous process. Bony destruction simulating periodontal disease occurred in the molar-premolar region and caused pain and paresthesia. Systemic sarcoid may occur more commonly in the jaws than reported cases would indicate. Sarcoidosis should be considered in the differential diagnosis when periodontal disease appears refractory to local therapy.