Heerfordt-Waldenström Syndrome: an under-recognised form of sarcoidosis

Correspondence to Kuganathan Ramasamy, Department of Otorhinolaryngology-Head & Neck Surgery, Hospital Tuanku Ja’afar, Jalan Rasah, Seremban 70300, Malaysia; kuganathan.ram@gmail.com I read with great interest the article entitled ‘Sarcoidosis with multiorgan involvement’ in the ‘Images’ section of the August 2020 print issue. 1 The authors have detailed the diagnostic dilemma encountered as the patient was initially treated for tuberculosis without any improvement before further work-up eventually pointed to sarcoidosis. [...]the presence of the classical symptoms, aided by adjuncts such as serologic test, chest X-ray and tissue biopsy provides adequate basis for diagnosis of HWS and hence, sarcoidosis. 4 It is interesting to note that the parotid enlargement and facial nerve palsy that constitute HWS also rank among the commonly encountered otorhinolaryngological manifestations of sarcoidosis. 5 Another prevalent and most common head and neck presentation of sarcoidosis is cervical adenopathy, where biopsy in the form of fine-needle aspiration or open method, could aid in the diagnosis of sarcoidosis by demonstrating the presence of non-caseating granuloma. 5 Corticosteroid remains the mainstay of treatment for HWS while other immunosuppressant drugs such as methotrexate and azathioprine may be useful in relapse or refractory cases. 5 Early diagnosis of HWS and the timely intervention are vital for a successful outcome. High index of suspicion among clinicians is required as they may pursue additional work-up to establish the diagnosis of sarcoidosis. [...]it is imperative to posit the need for a heightened awareness of HWS among the clinical fraternity.