Laryngeal Sarcoidosis: A Case Report Presenting Transglottic Involvement
Introduction
Sarcoidosis is a chronic granulomatous disease of uncertain etiology. It can affect any organ system of the body. Affected sites are mostly the lungs, hilar and mediastinal lymph nodes, liver, eyes, skin, bones, and nervous system. Head and neck involvement is rare, and isolated laryngeal involvement is even more exceptional. The estimated incidence of laryngeal involvement in patients with sarcoidosis is between 1% and 5%.1 Mostly it affects the supraglottis, less commonly the subglottis, and very rarely the true vocal folds.2 The diagnosis is based on clinical and radiological findings supported by histology, which shows noncaseating granulomas.3 Other causes of granulomas should be excluded.
The course of the disease is unpredictable. It may be self-limiting or progressive with exacerbations or remissions. Treatment depends on clinical presentation: severity of symptoms, whether the disease is systemic or isolated, and with or without airway impairment. The most used treatment is systemic corticosteroid, but local therapies such as intralesional corticosteroid injection or laser surgery have been described.4, 5
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Case report
A 35-year-old woman, originally from Suriname (South America), presented to our clinic with a 2-year history of progressive hoarseness.
She had previously visited an ear, nose, and throat surgeon who had referred her to a speech therapist. Besides hoarseness, which did not improve with speech therapy, she had developed shortness of breath during exertion in the last 6 months and snoring at night in the last 3 months. Laryngeal examination showed an altered aspect of the larynx with edema of the
Discussion
Sarcoidosis was first described by Hutchinson in 1875. It is also referred to as Boeck disease, who first reported the histological findings in 1899. The onset of sarcoidosis is typically between 20 and 40 years of age. It is slightly more common in women. Higher prevalence for African Americans has been identified in the United States.5 Sarcoidosis is a multiorgan disease most often involving the lungs, but it can also involve the upper airway, including nose, sinuses, and larynx. In 1982,
Conclusion
A case of isolated laryngeal sarcoidosis is described involving not only the supraglottic but also the glottic and subglottic areas. Presentation, diagnosis, and therapeutic options for laryngeal sarcoidosis are discussed. In this case, systemic corticosteroid was the treatment of choice with good result.
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Cited by (8)
Nonsquamous Pathologic Diseases of the Hypopharynx, Larynx, and Trachea
2020, Gnepp's Diagnostic Surgical Pathology of the Head and Neck, Third EditionLaryngeal Sarcoidosis in a Child: Case Report
2019, Reumatologia ClinicaProgressive Upper Airway Obstruction and Dysphagia in a Child with Supraglottic Edema
2020, JAMA Otolaryngology - Head and Neck SurgerySupraglottic laryngeal sarcoidosis masquerading as supraglottitis
2020, BMJ Case Reports