Internal illnesses. Sarcoidosis (Besnier-Beck-Schaumann disease) (lecture notes)

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Internal illnesses. Sarcoidosis (Besnier-Beck-Schaumann disease) (lecture notes)

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LECTURE No. 35. Sarcoidosis (Besnier-Beck-Schaumann disease)

Sarcoidosis is the formation of non-caseating epithelial and giant cell granulomas with the greatest localization in the lung tissue. At the same time, intrathoracic lymph nodes, liver, spleen, skin, eyes, nervous system, and heart can be affected.

Etiology. The cause of the disease is not clear.

Pathogenesis. The immunological mechanism of development is the suppression of the T-cell immune response. There is an activation of alveolar macrophages, their accumulation in the form of sarcoid granulomas.

Classification. Sarcoidosis has the following varieties: sarcoidosis of the lungs, sarcoidosis of the lymph nodes, sarcoidosis of the lungs with sarcoidosis of the lymph nodes.

When establishing a diagnosis, the nature of radiological changes is taken into account.

Clinic. At stage I of the disease, weakness, general malaise, subfebrile temperature, sweating, pain in muscles and joints, dry cough, shortness of breath, swelling of the joints appear, erythema nodosum appears on the skin of the extremities. There are no percussion changes. A small amount of dry and wet small bubbling rales is auscultated.

At the II stage of the disease, malaise, weakness, loss of appetite, weight loss, shortness of breath occurs already at rest. Percussion without changes. An increase in the number of dry and wet small bubbling rales, a pleural friction rub is auscultated.

At stage III of the disease, the symptoms of stage II are accompanied by cough with mucopurulent sputum, hemoptysis, cyanosis, and shortness of breath at rest. Auscultatory heard a significant amount of scattered dry and moist rales.

Additional diagnostic study. With a general blood test, there is a slight increase in ESR, lymphopenia, anemia. They conduct a biochemical blood test (dysproteinemia, an increase in α- and γ-globulins, hypercalcemia), an immunological blood test (a decrease in the activity of all parts of the immune response, a decrease in tuberculin sensitivity), a study of the function of external respiration (at stage I - an obstructive type of respiratory impairment; with Stage II - a mixed type of disorder; at stage III - a restrictive type of disorder), x-ray examination (at stage I - a bilateral increase in the size of the hilar intrathoracic lymph nodes, at stage II - the appearance of multiple foci in the lungs, mainly in the middle and lower sections and the root zone , at stage III - pronounced fibrosis, large, confluent focal formations).

Complications. Cardiopulmonary failure is the main complication of the disease.

differential diagnosis. Should be carried out with tuberculous bronchodenitis, lymphogranulomatosis, rheumatism, systemic connective tissue diseases, hepatitis.

Treatment. Patients are shown a diet with a large amount of protein, salt restriction. Glucocorticoids are prescribed (for all forms and stages of the disease), in courses of 3-6 months or more, the initial dose is 30-40 mg, the end of treatment after the clinical and radiological effect, aminoquinolones (delagil), potassium preparations, anabolic steroids (nerabol 5 mg per day). day, retabolil 50 mg 1 time in 2-3 weeks intramuscularly).

Flow. At stage I of the disease, a spontaneous cure is possible, at stage ii - recurrent, a cure is possible, at stage III - a slow progression of the disease.

Forecast. The prognosis is relatively favorable, mortality is from 2 to 5%.

Author: Myshkina A.A.

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