Systemic Sarcoidosis Revealed by a Nasal Lesion: A Case Report

A 62-year-old man presented with bilateral nasal obstruction and recurrent epistaxis episodes. Physical examination revealed normal body temperature and free cervical lymph nodes areas. Nasal endoscopy found a congestive nasal mucosa associated to bilateral inferior turbinate hypertrophy with a granular aspect of the right inferior turbinate. The biological examination showed lymphopenia, inflammatory syndrome, high serum level of angiotensin-converting enzyme and β2 microglobulin. Tuberculin skin test and Quantiferon gold were negative. The nasal and accessory salivary gland biopsies revealed granulomatous giant cell lesions non-caseating evoking systemic sarcoidosis. Ziehl-Neelsen staining and Lowenstein culture were negative. The diagnosis was systemic sarcoidosis revealed by nasal localization. The systemic extension research was negative. The treatment was based on corticosteroids (1 mg/kg/day) and gradual degression doses associated to a local nasal corticosteroid. The outcome was favorable with improvement of nasal obstruction and disappearance of initial lesions. The follow-up was 2 years.