August 2002

Case submitted by Youn W. Park, MD, and M. Akram Dar, MD

		CASE: A 36-year-old African-American woman complains of having difficulty breathing and nasal congestion, and exhibits lesions of the external nose. A chest x-ray shows bilateral hilar masses. An anterior rhinoscopic examination reveals swollen mucosal lesions as well.
What is your diagnosis?
		The patient has sarcoidosis. Biopsy specimens from the nasal turbinate mucosa and the external nasal lesion show noncaseating granulomatous changes. This disease of unknown etiology commonly affects young adults. In the United States, blacks are 10 times more likely to be affected than Caucasians. Chest films will show bilateral hilar lymphadenopathy or lung involvement in 90% of cases. Eye and skin lesions are next in frequency. Typical skin lesions are focal, slightly elevated, erythematous plaque; discrete subcutaneous nodules; or flat, reddened lesions resembling those of lupus erythematosus. Nasal findings include crusting and thickened mucosal lesions on the nasal turbinates and septum that cause bleeding, pain, and obstruction. The histologic diagnosis must be made by exclusion because other diseases, such as mycobacterial or fungal infections and berylliosis, can have similar presentations.

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Dr. Park is clinical professor of otolaryngology at Northeastern Ohio Universities College of Medicine and attending physician in the section of otolaryngology at Akron General Medical Center, Akron, Ohio. Dr. Dar is clinical associate professor of internal medicine, Northeastern Ohio Universities College of Medicine and section of pulmonary diseases at Akron General Medical Center.