Sarcoidosis is a chronic, systemic granulomatous disease capable of involving almost any organ in the body. It frequently involves the lymphatic system, lungs, liver, spleen, and bones. Although involvement of the epithelium of the upper respiratory tract is comparatively uncommon, nasal symptoms may be the first manifestation of this disease.
The etiology of sarcoidosis is unknown, but etiologic claims have been made for various infective agents, chemicals (including beryllium and zirconium), pine pollen, and peanut dust. It has also been associated with cell-mediated and humoralimmune abnormalities.
Sarcoidosis has a worldwide distribution, but the incidence is higher in northern Europe, the southern United States, and Australia. It occurs most commonly between the ages of 20 and 40 years. Women are slightly more often affected than men, and the disease is 10 to 20 times more prevalent in blacks than whites.
The clinical course in most cases is benign, with spontaneous resolution within 2 years, although 10% of cases may progress to pulmonary fibrosis. The lung is the primary organ affected by sarcoidosis, and 90% of patients have evidence of thoracic involvement, either enlarged intrathoracic lymph nodes or pulmonary parenchymal infiltrates. Approximately 40% of patients with sarcoidosis have granulomatous changes in extrapulmonary organs.
The involvement of the nose and paranasal sinuses by sarcoidosis is relatively infrequent, and most reports are anecdotal, so the true incidence of nasal involvement is not known with certainty. The observed incidence of histologically confirmed nasal involvement in large populations of patients with sarcoidosis has ranged between 1% and 6%. The most common symptom of nasal involvement is nasal obstruction, but epistaxis, dyspnea, nasal pain, epiphora, and anosmia may also occur.
Nasal sarcoidosis commonly affects the mucosa of the septum and inferior turbinate. The nasal mucosa is usually dry and friable with crusting. Submucosal nodules with a characteristic yellow color may be noted; these nodules are the macroscopic presentation of intramucosal granulomas, which can be identified in mucosal biopsy specimens. In more advanced disease, irregular polypoid mucosa is seen, which is friable and bleeds readily. More severe infiltration may lead to septal perforation or even oronasal fistulae.
Paranasal sinus involvement in sarcoidosis often accompanies nasal mucosal involvement. Mucous membrane thickening or opacification of paranasal sinuses occurs. Some patients with nasal sarcoidosis have bony lesions of the nasal bones; such lesions are a response to granulomas within the bone and may appear as scattered regions of osteoporosis or zones of frank destruction. The suture lines may disappear, but no periosteal reaction is seen.
Source: Cummings Otolaryngology, 6E (2015)