Sarcoidosis manifesting as isolated nasal crusting and dysphonia

We present a case of isolated sinonasal and laryngeal sarcoidosis without pulmonary or other disease manifestations. This case adds to the growing body of literature on sinonasal and laryngeal sarcoidosis. A 46-year-old female presented initially for nasal crusting that progressed to include dysphonia as well. After multiple nasal debridements and biopsies, negative chest x-ray, and persistent symptoms despite steroids, laryngoscopy was performed which showed thick endolaryngeal mucus and edematous supraglottis. Nasal biopsy revealed granulomatous inflammation with rare calcifications and bloodwork showed elevated inflammatory markers and angiotensin converting enzyme (ACE) level. The patient was diagnosed with sinonasal and laryngeal sarcoidosis. The patient did not initially have abnormalities on chest x-ray but developed hilar lymphadenopathy later during her management. She has been managed effectively on low dose methotrexate. This case highlights the importance of evaluation for underlying rheumatologic disease in the context of persistent sinonasal and laryngeal inflammation, even if other more common presenting systemic signs and symptoms are absent.