Elsevier

Journal of Voice

Volume 27, Issue 5, September 2013, Pages 647-649
Journal of Voice

Laryngeal Sarcoidosis: A Case Report Presenting Transglottic Involvement

https://doi.org/10.1016/j.jvoice.2013.03.010Get rights and content

Summary

Isolated laryngeal sarcoidosis is a very rare disease. In most cases, it will present as a supraglottic pale edematous swelling. In our case, the patient presented with hoarseness and dyspnea during exertion. Laryngeal examination did show not only supraglottic edema but also prominent subglottic swelling and edematous true vocal folds. Histology showed noncaseating granulomas. After excluding other causes and localizations, the patient was diagnosed with laryngeal sarcoidosis and treated with systemic corticosteroid with good result. We describe our case of isolated transglottic sarcoidosis and discuss the disease, its presentation, diagnosis, and therapeutic options.

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

Section snippets

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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