B. Sarcoidosis
Sarcoidosis is a chronic granulomatous disease of unclear etiology. Its prevalence is about 10 to 35 cases per 100 000 people, with a significant African American and female predominance.1 The disease tends to affect those in the third or fourth decade of life, most often manifesting as cough or dyspnea.2 Sarcoidosis affects the head and neck region in 10% to 15% of patients and usually presents as cervical lymphadenopathy.3
The reported rate of laryngeal sarcoidosis ranges from 0.5% to 5% of all patients with sarcoidosis, and isolated laryngeal sarcoidosis is rarer still.2,4 Symptoms may include hoarseness, dyspnea, snoring, dysphagia, globus, and throat pain.2 Laryngoscopy shows pale edema of the epiglottis most commonly, followed by the arytenoids and aryepiglottic folds. The epiglottis may have a characteristic turbanlike appearance, as seen in this patient (Figure 1A).5 The glottis and subglottis are less frequently involved, likely owing to less lymphoid tissue in these areas.2,5 While sarcoidosis is a diagnosis of exclusion, serum ANA and ACE levels may be elevated, although the latter has low sensitivity (60%).2 Because ACE is primarily secreted by pulmonary endothelial cells and alveolar macrophages, levels may be normal in patients without pulmonary involvement.6 Histopathology will reveal noncaseating granulomas, as it did in this patient.