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Sarcoidosis confined to the airway masquerading as asthma: DISCUSSION (2)

Although there seemed to be a temporal relation between the treatment and the patient’s response, the treatment course was much shorter than recommended . Resolution of airway edema may explain this rapid response. Spontaneous resolution of sarcoidosis occurs in up to two-thirds of patients , but endobronchial involvement, on the other hand, is reported to convey a worse prognosis . Inhaled glucocorticoids may improve cough , and this patient was an appropriate candidate because CT scan did not reveal any infiltrates. The use of systemic glucocorticoids followed by inhaled glucocorticoids has been shown to be more effective than placebo in stage II pulmonary disease and is somewhat similar to the treatment that our patient received.

Sarcoidosis can mimic asthma by different potential mechanisms. Symptoms such as cough and wheezing may be due to bronchostenosis, focal endobronchial lesions or extrinsic compression by lymph nodes, but airway hyper-reactivity may also play a role . The latter might have been present in our patient, as evidenced by persistent, nonproductive cough and intense erythema of the airway at presentation, though confirmation with methacholine challenge testing was not undertaken. A FVL can be helpful but is not sensitive enough to exclude obstruction of the major airways. Sarcoidosis should be included in the differential diagnosis of persistent asthma, even if a plain radiograph does not exhibit features of this disease and extrapulmonary clinical findings are absent. A CT scan of the chest may prove useful in prompting further investigation with bronchoscopy. More often than not, biopsy of abnormal appearing bronchial mucosa leads to the diagnosis.

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