Vocal Folds: An Unusual Hideout for Systemic Sarcoidosis

Sarcoidosis is a chronic inflammatory granulomatous disease of unknown etiology. It can expand to all organs and tissues. Lungs and lymph nodes are the most commonly involved tissues. Laryngeal sarcoidosis is rare, accounting for no more than 1% of patients with systemic sarcoidosis. We herein report the case of a 51-year-old female presenting a two-year history of persistent voice hoarseness with direct laryngoscopy findings of epiglottis swelling and irregular swelled and bruised left vocal fold. Histological examination highlighted the presence of non-caseating granulomas. Further investigations revealed similar histological findings in the nasal cavity as well as lymphocytic alveolitis. It also showed the presence of phalangeal bone lesions of both hands. All these pointed to the diagnosis of sarcoidosis with upper respiratory tract (nasal and laryngeal), lung and bone involvement. The patient was started on 0.5 mg/kg daily of prednisone for 1 month followed by progressive tapering with lasting favorable outcome.