Sarcoidosis is a condition where tiny clumps of inflammatory cells, called granulomas, can form in different parts of your body. Most commonly, these show up in the lungs, but they can also appear in your sinuses.
When sarcoidosis affects the sinuses, it can cause symptoms similar to chronic sinusitis or allergies. This might include:
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Nasal obstruction or stuffiness: Feeling like your nose is constantly blocked.
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Runny nose (rhinorrhea): Persistent nasal discharge.
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Nasal crusting: Formation of crusts inside the nose.
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Nosebleeds (epistaxis): Occasional bleeding from the nose.
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Facial pain or pressure: Discomfort around the forehead, cheeks, or eyes.
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Anosmia (loss of smell): Difficulty or inability to smell.
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Nasal polyps: Soft, non-cancerous growths inside the nasal passages.
Because these symptoms are so common in other conditions, sinonasal sarcoidosis can sometimes be overlooked. Diagnosis often involves a biopsy of the nasal tissue to confirm the presence of the characteristic granulomas.
Treatment for sinonasal sarcoidosis aims to reduce inflammation and manage symptoms. This often involves:
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Corticosteroids: These are powerful anti-inflammatory medications, which can be given as nasal sprays, oral pills, or even injected directly into the affected area.
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Immunosuppressants: For more severe or persistent cases, medications that suppress the immune system might be used.
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Nasal irrigation and humidification: To help clear the nasal passages and keep them moist.
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Surgery: In some cases, endoscopic sinus surgery might be recommended to clear blockages or remove polyps, especially if medications aren't enough.
While sarcoidosis can be a chronic condition, many people with sinonasal involvement respond well to treatment, and their symptoms improve."
"Sinonasal sarcoidosis, a less prevalent extrapulmonary manifestation of systemic sarcoidosis, involves the formation of non-caseating granulomas within the sinonasal mucosa and paranasal sinuses. While the lungs and mediastinal lymph nodes are most commonly affected in sarcoidosis, sinonasal involvement is reported in approximately 1-5% of cases, though its true incidence may be underestimated due to its clinical mimicry of more common chronic rhinosinusitis pathologies.
Clinical presentation often includes:
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Nasal obstruction/congestion
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Rhinorrhea
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Epistaxis
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Nasal crusting
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Anosmia
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Facial pain/pressure
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Presence of nasal polyps or friable nasal mucosa on endoscopy
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In some cases, associated cutaneous sarcoidosis, particularly lupus pernio, may be observed on facial skin.
Diagnostic confirmation relies on histopathological examination of biopsied sinonasal tissue, revealing characteristic non-caseating granulomas. Imaging studies, such as CT scans of the paranasal sinuses, typically demonstrate mucosal thickening, opacification, and occasionally bony erosions or osteoneogenesis. Differential diagnoses include other granulomatous conditions like tuberculosis, fungal infections, and granulomatosis with polyangiitis.
Therapeutic approaches are primarily aimed at reducing granulomatous inflammation and mitigating symptoms:
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Corticosteroids: Both topical (nasal sprays) and systemic corticosteroids (e.g., prednisone) are first-line agents. Topical steroids are often used for localized disease, while systemic steroids are reserved for more extensive or recalcitrant cases, or when other systemic involvement necessitates their use.
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Immunomodulators/Immunosuppressants: For corticosteroid-resistant disease or to minimize steroid-related side effects, agents such as methotrexate, azathioprine, or hydroxychloroquine may be employed. Anti-TNF-alpha antibodies (e.g., infliximab, adalimumab) represent a newer class of biologics that have shown efficacy in refractory cases.
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Adjuvant therapies: Nasal saline irrigations and humidification contribute to symptomatic relief and mucociliary clearance.
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Surgical intervention: Functional Endoscopic Sinus Surgery (FESS) may be considered for symptomatic relief, debridement of inflammatory tissue, or to address anatomical obstruction, particularly in cases of chronic sinusitis superimposed on sarcoidosis that are unresponsive to medical management."