Orbital Sarcoidosis Masquerading as Acute Frontal Sinusitis
نویسندگان
چکیده
Sarcoidosis is a chronic systemic disease that rarely manifests within the sinuses or orbit. A 65-yearold female presented with 2 weeks of eye proptosis and forehead pressure. A computed tomography scan revealed frontal sinus opacification. The initial diagnosis of orbital cellulitis secondary to frontal sinus infection was made but symptoms returned after medical therapy. Biopsy of preaponeurotic fat revealed non-caseating granuloma, consistent with sarcoidosis. Extrapulmonary involvement by sarcoidosis is observed in ~30-40% of patients; however, orbital sarcoidosis presents as the initial manifestation in only 1.5-12.4% of patients. The presentation is often confounded by sinonasal symptoms, which may delay the diagnosis. Joshua B Greene1*, Christian George2 and Robert Deeb1 1Department of Otolaryngology-Head & Neck Surgery, Henry Ford Health System, USA 2Department of Ophthalmology, Henry Ford Health System, USA Joshua B Greene, et al., Annals of Clinical Otolaryngology Remedy Publications LLC. 2017 | Volume 2 | Issue 1 | Article 1008 2 Discussion Sarcoidosis is a chronic idiopathic systemic disease, that may involve the head and neck region in 10%-15% of cases [5,6]. Those with sinonasal involvement typically present with symptoms of chronic crusting rhinitis, nasal obstruction, and anosmia [7]. A recent review by Lawson et al. [7] proposed a new system of classification that subtypes sinonasal sarcoidosis into 1 of 4 categories: atrophic, hypertrophic, destructive or nasal enlargement. This classification can act as a guide to diagnosis and treatment. The challenge in the diagnosis and management of sinonasal sarcoidosis is that the presentation is often indistinguishable from other conditions, such as chronic rhinosinusitis, granulomatosis with polyangitis, allergic rhinitis, atrophic rhinitis and natural killer/Tcell lymphoma. The diagnosis of sarcoidosis is based on clinical examination, radiographic studies, biopsy and laboratory analysis [8]. Histopathology shows non-caseating granulomas. Angiotensinconverting enzyme levels may reflect systemic disease activity, being elevated with active disease and normal when quiescent. The data regarding sinonasal sarcoidosis is mostly limited to case reports and case series. As such, it is difficult to ascertain the frequency with which both sinonasal and orbital involvement occur in the same patient. It is generally believed to be a rare finding. Bronson and Fisher reported the first case of sinonasal sarcoidosis with extension to the orbit in 1976 [9]. Baughman et al. [10] found that patients with both sinonasal and ocular sarcoidosis often have lacrimal gland involvement and can present with dacrocystitis. This case highlights the importance of maintaining a broad differential diagnosis in those patients presenting with sinus and orbital inflammation and having an atypical response to treatment. Conclusion Sarcoidosis is a common granulomatous disease with rare extrapulmonary involvement of the eye or sinonasal tract. Although its presentation may be confounded by more common disease processes, it is important to consider sarcoidosis in patients who present with recurrent isolated sinonasal and ocular symptoms.
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