Sino-Nasal Sarcoidosis

Abstract

Sino-nasal sarcoidosis is an infrequent but serious complication of sarcoidosis. Sarcoidosis patients with sino-nasal involvement usually have chronic disease. Involvement of the paranasal sinuses is usually detected by imaging, which can demonstrate destruction of tissue and/or replacement with granulomatous inflammation. Although the diagnosis may be suggested by visualization, biopsy confirmation is highly supportive of the diagnosis. In some cases, local corticosteroids may be sufficient to control inflammation. However, many patients require systemic therapy. While glucocorticoids are first-line therapy, steroid-sparing agents such as methotrexate are often employed to minimize toxicity. In some cases, third-line agents, including the antitumor necrosis factor monoclonal antibodies such as infliximab, are needed to control the inflammation. Recurrent infections may complicate the management of sino-nasal disease.