THU0403 Sinonasal sarcoidosis: Review of clinical and imaging features: 7 year experience

• Published in: Annals of the rheumatic diseases Vol. 71; no. Suppl 3; pp. 291 - 292
• Main Authors: Joshi, R., Zenga, J., Getz, A., Debnath, N.
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and European League Against Rheumatism 01.06.2013; BMJ Publishing Group LTD
• ISSN: 0003-4967; 1468-2060
• DOI: 10.1136/annrheumdis-2012-eular.2368

Background Sarcoidosis is a chronic granulomatous disease that affects multiple organ systems including the upper respiratory tract. Sinonasal involvement is rare. Objectives Objective is to describe clinical characteristics of patients with sinonasal sarcoidosis and determine whether these patients exhibit characteristic sinus computed tomography (CT) findings based on Lund-Mackay scores (LM). Methods A retrospective review performed on 39 patients presenting to a tertiary academic medical center with a biopsy-proven diagnosis sarcoidosis and paranasal sinus CT imaging from 2004-2011. Results: Patient characteristicsFrequency in our cohort ( n=39) Mean Age48 years M:F ratio1:3 African American82% Mean LM score6.2 Presence of lupus pernio5% (n=2) Neoosteogenesis15.3% Bony erosions7.7% Nodular sinonasal mucosal thickening20.5% Septal Perforation2% ( n=1/ 39) Evidence of pulmonary sarcoidosis41% Chronic sinonasal complaints69% Use of intranasal steroids100% Use of systemic steroids45% Use of steroid sparing agents48%  Methotrexaten=12  Azathioprinen=5  Mycophenolate mofetiln=3  Infliximabn=2 One patient is on Rituximab salvage therapy, after failing all other steroid sparing agents. Main side effects include iatrogenic Cushing’s, opportunistic infections (OIs) and osteopenia. OIs include nontuberculous mycobacterial infection, cryptococcal osteomyelitis and Aspergillus niger infection. Incidentally 4 unusual cancers were noted: lacrimal gland sarcoma, inferior turbinate carcinoma-in-situ, myeloma and metastatic ovarian carcinoma. Conclusions Lund-Mackay score is an assessment tool to facilitate treatment decisions in chronic rhinosinusitis. Mean “normal” LM score in patients who undergo head imaging for non-rhinologic reasons is 4. Sinonasal sarcoid involvement has been estimated between 0.7 to 6% in various studies, but true incidence remains unclear due to nonspecific symptoms and lack of physician awareness. Mean LM score in sinonasal sarcoid may not elevated. However, the presence of nodular mucosal thickening of the nasal cavity, septum and sinuses may suggest sinonasal involvement of this chronic granulomatous disease in patients with symptoms of sinusitis. Single center experience of first line steroid sparing agent is Methotrexate, although individual patient co-morbidities drive this decision. Although uncommon, coexistent sinonasal sarcoidosis should be considered during the evaluation of sarcoid patients. References Reed J, DeShazo R, Houle T et al. Clinical features of Sarcoid Rhinosinusitis. The American Journal of Medicine, 2010, 123: 856-862. Hopkins C, Browne J, Slack R et al. The Lund-Mackay staging system for chronic rhinosinusitis: How is it used and what does it predict? Otolaryngology- Head and Neck Surgery, 2007, 137: 555-561. Disclosure of Interest R. Joshi: None Declared, J. Zenga: None Declared, A. Getz: None Declared, N. Debnath Consultant for: Entellus Medical, Speakers Bureau: Alcon