49-year-old woman with refractory chronic sinusitis. Sarcoidosis with granulomatous sinusitis Photo Quiz

ABSTRACT

A 49-year-old married, non- smoker housewife had purulent rhinorrhea, nasal congestion, post nasal drip [PND], and feeling of sinus pressure following an episode of common cold. She had no complaints of fever, cough, dyspnea, or arthralgia. Physical examination revealed PND and a posterior auricular lymphadenopathy [1cm X 1cm]. The patient received amoxicillin for 2 weeks with mild improvement. But again, she experienced the exacerbation of signs and symptoms a week later. CT-scan of the paranasal sinuses was performed [Figure 1]. She also had erythematous patches on her face around the right eye and her back, along with splenomegaly. The patient was treated with amoxicillin/clavulanate [for two weeks], loratadine, and beclomethasone nasal spray as well as normal saline nasal wash. There was a slight improvement in patient's signs but, repeatedly after two weeks signs and symptoms exacerbated. Due to the lack of response to antibiotics, a biopsy of the skin lesion was taken which revealed the following histopathological findings: