Clinical features of sarcoidosis patients presenting with head and neck manifestations – a two-center retrospective study and proposal of a diagnostic algorithm for the otorhinolaryngologist

Abstract

Background and Aims: We aimed to investigate the clinical characteristics of patients presenting with sarcoidosis of the head and neck as the initial manifestation and to provide recommendations for the diagnostic work-up for the practicing otorhinolaryngologist.

Material and Methods: We performed a retrospective cohort study at two university medical centers in Germany. Patients with a histopathologically confirmed diagnosis of sarcoidosis treated in the otorhinolaryngology departments were analyzed.

Results: We identified 62 patients (2003–2016). In total, 85.4% (n = 53) of patients received the initial diagnosis of sarcoidosis during their ENT treatment. Sarcoidosis was detected in the lymph nodes in 42.3% (n = 30) of the patients; 57.7% had extra-lymphatic manifestations. Fifteen patients (24.2%) showed pulmonary involvement. 30.6% (n = 19) were treated with oral glucocorticoids (GC) alone, three patients with GC and methotrexate, one patient initially received a combination of GC and azathioprine, one patient rejected the recommended treatment.

Conclusions: Sarcoidosis should be considered as a differential diagnosis in patients presenting with head and neck symptoms. The most frequent presenting symptoms were cervical lymphadenopathy and affection of the paranasal sinuses. Therefore, otorhinolaryngologists should be aware of sarcoidosis and help guide referral strategies as they may be the first physicians treating these patients.

Chinese abstract

背景与目的：探讨以头颈部结节病为首发症状的患者的临床特点, 为耳鼻咽喉科执业医师的诊断工作提供参考。

材料与方法：我们在德国两所大学医学中心进行了回顾性队列研究。对耳鼻咽喉科确诊为结节病的患者进行分析。

结果：我们确定了62名患者（2003-2016年）。共有85.4%（n = 53）的患者在耳鼻喉科治疗期间得到结节病的初步诊断。淋巴结结节病占42.3%（n = 30）, 57.7%有淋巴结外表现。15例（24.2%）表现为肺部受累。单用糖皮质激素（GC）治疗30.6%（n =19）, GC和甲氨蝶呤治疗3例, GC和硫唑嘌呤联合治疗1例, 拒绝接受所荐治疗1例。

结论：对于有头颈部症状的患者, 结节病应作为鉴别诊断。最常见的症状是颈部淋巴结病变和副鼻窦病变。因此, 耳鼻咽喉科医生应了解结节病, 并帮助指导这些病人的转诊策略, 因为他们可能是治疗这些病人的第一批医生。

Keywords:

• Extrapulmonary sarcoidosis
• lymph nodes
• sarcoidosis
• granulomatous disease
• head neck

Disclosure statement

The authors declared no potential conflicts of interest.