Severe laryngeal sarcoidosis in a child managed by intralesional steroid, debulking, and methotrexate

Laryngeal sarcoidosis is a rare condition, particularly in the pediatric population. Acute airway intervention may be required in severe cases, but guidelines to support the therapeutic strategy are absent. Moreover, evidence regarding systemic therapy is scarce. This encouraged us to report the result of airway management and systemic methotrexate at a one-year follow-up in a child with severe laryngeal sarcoidosis. A 14-year-old Caucasian female presented with dyspnea, dysphagia, and hoarseness. Fiberoptic laryngoscopy revealed profound swelling of the epiglottis and the arytenoid regions. Laryngeal sarcoidosis was suspected, and direct laryngoscopy, including biopsies, cold steel debulking, and intralesional corticosteroid injections, was performed to secure the airway. Histology was compatible with sarcoidosis, and long-term therapy with methotrexate was prescribed. At one-year follow-up, the patient was asymptomatic, and fiberoptic laryngoscopy demonstrated a near complete remission.