Airway involvement and obstruction from granulomas in African–American patients with sarcoidosis

Abstract

Sarcoidosis is a global disorder whose breadth of organ involvement can often be underappreciated. Head and neck manifestations include involvement of the skin, salivary glands, sinonasal cavity, and larynx. Of cases of upper airway sarcoidosis, laryngeal sarcoidosis and airway compromise portend a greater risk of fatal outcomes. People representing all racial groups have been diagnosed with sarcoidosis. Although many studies have evaluated incidence and manifestations of sarcoidosis in multiple ethnicities, few studies have explored racial predilection for laryngeal involvement. However, assertions that disease severity and poor outcome may be tied to the African diaspora as well as related socio-economic and cultural realities have been recognized. We present our case series of six African-American patients diagnosed with sarcoidosis and presented with complaints of voice change and increased shortness of breath. Four of them required expeditious, surgical management of the airway. Two had limited supraglottic involvement and have avoided tracheotomy with aggressive and timely pharmacotherapeutic intervention and close clinical surveillance. Early recognition of laryngeal manifestations of sarcoidosis and airway compromise is essential to provide patients with conservative management without the need for aggressive surgical intervention.

Sarcoidosis and its otolaryngological implications

“…The frequency of this localisation is conWrmed by a majority of studies on laryngeal sarcoidosis and case reports [27][28][29][30][31][32][33]. A diVerence in localisation was seen in the series of six African-American patients with laryngeal sarcoidosis, in which only two patients had limited supraglottic involvement and avoided tracheotomy, whilst four had extensive sarcoid granulomas involving two or three sections of the larynx and required surgical management due to upper airway obstruction [34].…”

“…The diVerential diagnosis of laryngeal sarcoidosis includes epiglottitis, granulomatous laryngitis of another cause, including tuberculosis, histoplasmosis, blastomycosis, coccidioidomycosis, syphilis and actinomycosis, malignant neoplasm, cartilaginous tumours and rare diseases of the larynx such as Wegener's granulomatosis and amyloidosis [27][28][29][30][31][32][33][34][35][36][37].…”

“…Low-dose external beam radiation therapy is an alternative treatment modality in adults in whom intralesional steroids or local granuloma excisions are not feasible and in those who are refractory to systemic steroids [27][28][29][30][31][32][33][34][35][36][37].…”

Sarcoidosis-like granulomatosis of the hypopharynx as a complication of anti-TNF therapy

“…However, involvement of nearly every part of the mucosa of the respiratory tract from the nasal cavity to the peripheral bronchioles has been described [9]. Localized, symptomatic laryngeal involvement is relatively rare [10]. A 31-year review at Mayo clinic identified 220/2319 (9%) patients with head and neck manifestations suffering from sarcoidosis.…”

Adult Supraglottic Stenosis: Etiology and Management

“…Localized laryngeal disease is treated with resection using CO 2 laser with local steroids or mitomycin-C. Open surgical excision and external radiation therapy may be also used. 33 Amyloidosis is usually localized in the head and neck area, treatment with surgical excision is usually successful for symptomatic cases. In the larynx, a conservative resection using microlaryngeal surgical approach is recommended with preservation of the surrounding tissue.…”