Sarcoidosis

Sarcoidosis is a systemic disease of unclear etiology, characterized by the formation of granulomas in the tissues, consisting of epithelioid cells and single giant cells of Pirogov-Langhans or the type of foreign bodies. Granulomas are the same type, round ("stamped"), clearly delimited from the surrounding tissue. Unlike the tuberculous tubercles, they lack caseous necrosis. Sarcoidosis occurs mainly in young and middle age, somewhat more often in women. Almost all organs, mainly lymph nodes, lungs, liver, spleen, less often the kidneys, skin, eyes, bones, etc. are affected. Most often, the respiratory organs are affected.

Symptoms, course. Stage 1 is characterized by an increase in the intrathoracic lymph nodes. In stage II, along with this, pronounced interstitial changes and foci of different sizes are predominantly found in the middle and lower sections of the lungs. In the third stage, significant diffuse fibrosis in the lungs and large, usually draining foci, as well as pronounced emesis often occur with bullous-dystrophic and bronchiectatic cavities and pleural seals. Approximately one third of patients with stage I and II have no noticeable subjective disorders and the disease is detected by X-ray fluorography. The course is subacute or chronic, often wavy; Weakness, subfebrile condition, chest pain, dry cough, decreased appetite. The wheezing in the lungs is rarely heard and in a small amount. Sometimes sarcoidosis begins acutely with high fever, swelling of the joints of the limbs, the appearance of erythema nodosum, mainly on the skin of the shins, an increase in the external lymph nodes. In the blood - the incidence of climptopenia and monocytosis, less often eosinophilia; ESR within normal limits or not greatly enlarged. A characteristic feature is a decrease in general and local sensitivity to tuberculin, and therefore Mantoux test is usually negative. Characteristic positive reaction Kweim. At the III stage of the disease, these signs are more pronounced, dyspnea and cyanosis gradually increase. The duration of the disease is from several months to many years. In addition to the clinical and radiologic picture, the diagnosis is confirmed by the results of histological or cytological examination of lymph nodes, skin, bronchial mucosa and lung tissue, where elements of sarcoid granuloma are found. In this way, it is possible to differentiate sarcoidosis from tuberculosis, various dissemination in the lungs and other diseases.

Treatment is nonspecific with the use of mainly glucocorticoids. Given the possibility of spontaneous recovery, corticosteroids are usually prescribed after 3-5 months of observation if the process has no inclination to spontaneous involution. In early terms, hormone therapy is indicated with obvious progression, generalization of the process, with eye, kidney, skin, cardiovascular and nervous system lesions. For the most part, prednisolone is prescribed at 30-40 mg / day, and then in gradually decreasing doses for 6-12 months, sometimes even longer. If it is impossible to apply hormone therapy or if it is not effective, use hingamine (delagil) 0.25 g 1-2 times a day, vitamin E at 300 mg / day.

The prognosis is overwhelming in most cases. At the III stage as a result of slowly increasing pulmonary-cardiac insufficiency, a lethal outcome is possible.