Title: An oral lesion as the primary manifestation of sarcoidosis: a case report
Abstract: Background: Sarcoidosis is a multi-systemic disease of unknown aetiology predominantly characterised by non-caseating granulomas in the lungs and lymph nodes. Oral involvement of this disease, particularly as the first clinical presentation, is rare. Case Report: A 39-year-old female presented with a history of long standing, asymptomatic well defined swelling on the hard palate. This was located adjacent to a grossly carious upper left first molar with a large periapical radiolucency. An incisional biopsy of the lesion was performed under local anaesthetic, which revealed a non-caseating granulomatous inflammatory reaction with absence of acid-fast bacilli. The first molar was extracted and patient subsequently reviewed with the swelling markedly reduced in size but still persistent. In light of the histological findings, a referral was made to respiratory medicine and further investigations revealed a small granulomatous lesion in the upper lobe of the left lung. On further questioning, the patient revealed a history of a long-term cough and shortness of breath on exertion. A diagnosis of stage II sarcoidosis with pulmonary involvement was eventually made and she was placed on prednisolone for two months and reviewed. Conclusion: Although extremely rare, oral lesions of sarcoidosis may be the first presenting feature and can mimic other granulomatous conditions such as tuberculosis. It is important that clinicians are aware of and investigate all possibly causes of swellings including underlying systemic disease and refer if necessary to the appropriate specialty.