Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
To the Editor: In their Contempo Updates article
about sarcoidosis, Drs Thomas and Hunninghake did not discuss otolaryngologic
features, such as nasal congestion or bleeding, which can lead to early diagnosis.1 In the Washington, DC, area, about 30% of patients
have otolaryngologic manifestations and in about 20% the presenting symptom
is due to involvement of the upper aerodigestive tract, the cervical lymph
nodes, or the salivary glands.2,3 The
onset of unexplained cough should prompt an otolaryngologic evaluation since
the cough may be caused by laryngotracheal sarcoidosis. Indeed, the upper
airway is a frequent target organ of the most important diagnostic differentials
of sarcoidosis including Wegener granulomatosis, fungal and mycobaterial infections,
rhinoscleroma, relapsing polychondritis, T-cell lymphoma, and AIDS.4 All these multisystem diseases may present with
nasal stuffiness and crusting, and hence, can be diagnosed early by nasal
biopsy.5 Clearly, the nose would be much
more accessible than the lungs.
Deeb ZE, Otteson TD. Early Diagnosis of Sarcoidosis—Reply. JAMA. 2003;290(11):1454. doi:10.1001/jama.290.11.1454-a
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