Internal illnesses. Sarcoidosis (Besnier-Beck-Schaumann disease) (most important)

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Internal illnesses. Sarcoidosis (Besnier-Beck-Schaumann disease) (most important)

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40. SARCOIDOSIS (BENE-BECK-SCHAUMANN DISEASE)

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

The disease is relatively rare, more common in men in young and middle age.

Etiology. The cause of the disease is not clear.

Pathogenesis. The immunological mechanism of development is inhibition of the T-cell immune response. Alveolar macrophages are activated and accumulate in the form of sarcoid granulomas.

Classification. It has varieties: pulmonary sarcoidosis, lymph node sarcoidosis, pulmonary sarcoidosis with lymph node sarcoidosis.

Clinic. Main syndromes: damage to lung tissue, dermatological, arthropathic, otthalmological. At stage I of the disease, weakness, general malaise, low-grade fever, sweating, pain in muscles and joints are noted, a dry cough appears, shortness of breath, swelling of the joints, and erythema nodosum appears on the skin of the extremities. There are no percussion changes. On auscultation, a small amount of dry and moist fine bubbling rales are heard.

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.

Diagnostic research. With a general blood test, there is a slight increase in ESR, lymphopenia, anemia. They conduct a biochemical blood test (dysproteinemia, an increase in a- and g-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 violation; at stage III - a restrictive type of violation), X-ray examination (with

Stage I - bilateral increase in the size of the hilar intrathoracic lymph nodes, with

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).

Treatment. Patients are advised to eat a diet with plenty of protein and limit salt. Glucocorticoids are prescribed (for all forms and stages of the disease), in courses of 3-6 months or more, initial dose of 30-40 mg, end of treatment after clinical and radiological effect, aminoquinolones (Delagil), potassium preparations, anabolic steroids (non-bolic 5 mg per day, retabolil 50 mg once every 1-2 weeks intramuscularly).

Flow. In stage I of the disease, spontaneous recovery is possible, in stage II - recurrent, cure is possible, in stage III - slow progression of the disease.

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

Author: Myshkina A.K.

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