A 47-year-old Ethiopian with known biopsy-proven mucocutaneous facial sarcoidosis presented with dyspnea which had been rapidly progressive over a few weeks, hoarseness and stridor. Examination revealed a biphasic stridor; pulmonary function testing showed marked limitation of in- and expiratory flow rates and FEV_1 was reduced to 2.19 liters (58% of predicted value). Empey index [1] was 12.3 [FEVi (ml)/PEF (1/min)] consistent with fixed upper airway obstruction (fig. la). Further investigation of the larynx revealed circular narrowing (fig. lb) and severe sarcoid involvement with a remaining dorsal glottis of 5 mm only (fig. lc).
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