Clinical manifestations, radiographic findings, treatment options, and outcome in sarcoidosis patients with upper respiratory tract involvement.

BACKGROUND

Sarcoidosis of the upper respiratory tract (SURT) is an underappreciated manifestation of sarcoidosis. We described the clinicoradiological findings, methods of treatment, and outcomes of 68 patients with SURT seen in our clinic over a 7-year period.

METHODS

This was a retrospective study. A Case Control Etiology of Sarcoidosis Study (ACCESS) instrument of organ involvement was used to classify patients with SURT. Patients with a definite or probable diagnosis of SURT underwent chart review for symptoms, radiological features, treatment, and outcome.

RESULTS

There were 6.8% (68/998) of patients in the sarcoidosis clinic who had SURT. The most common presenting symptom was nasal congestion (61%, 34/56). In patients who had SURT diagnosed after the initial presentation of sarcoidosis, the mean prednisone dose more than quadrupled (4 + or - 6.5 vs 18.6 + or - 15.9, P = 0.002) between the diagnosis of SURT and the end of follow up. By the end of follow up, only 40% of our cohort had significant improvement of SURT.

CONCLUSION

SURT is a form of sarcoidosis that is not uncommon. Relatively high doses of corticosteroids are required to control the disease, and improvement occurs in a minority of the patients although the disease usually can be stabilized. Surgery should be reserved for life-threatening complications as surgical outcomes are relatively poor.