Sarcoidosis of the nose: causes, symptoms, diagnosis, treatment

Sarcoidosis is a general disease affecting the reticulohistiocytic system, occurring in forms from the mildest, not affecting the general condition of the body, to severe, disabling and even fatal forms. It is known as Beck's disease or Besnier-Beck-Schaumann disease. Refers to systemic diseases with a chronic course, characterized by the formation of specific granulomas in various organs and tissues. Sarcoid granulomas differ from tuberculous granulomas mainly by the absence of necrotic changes. Fibrosis may develop in the affected organs, leading to persistent dysfunction of the affected organs.

The cause of sarcoidosis has not been fully studied. In the late 19th and first half of the 20th century, this disease was associated with tuberculosis, but this hypothesis was not confirmed. Other "theories" of the etiology of sarcoidosis, such as the role of leprosy, syphilis, beryllium, microscopic fungi, viruses, etc., also turned out to be unconvincing. According to modern concepts, sarcoidosis is a disease of impaired immunoreactivity with a special reaction of the body to the impact of various environmental factors.

Pathological anatomy. The main morphological substrate of sarcoidosis is a tuberculoid granuloma, resembling a tuberculous tubercle. The main element of this granuloma, both qualitatively and quantitatively, is the epithelioid cell. In a typical histological picture of skin sarcoidosis, sharply defined and separated from the epidermis and from each other, single granulomas are found in the deep and middle parts of the dermis, consisting almost exclusively of epithelial cells with a narrow lymphoid-cell rim along the periphery without signs of caseous necrosis. Blood vessels are often found in a sarcoid granuloma (in contrast to a tuberculous tubercle). Another of its cellular elements is giant cells of the Langhans type, which, unlike tuberculosis, are not always found and in small quantities. Of great differential diagnostic importance is the absence of an inflammatory zone of polymorphonuclear leukocytes in sarcoid granuloma. Sarcoidosis of the nose is manifested by the appearance of dense bluish nodules on the skin, the seeding of which is periodic and can last for decades. These nodules tend to ulcerate with the formation of granulation tissue around the circumference, and caseous necrosis may occur in small quantities, which is why they are similar to nodules that occur in lupus and leprosy. Microscopy of the nasal mucosa reveals similar pale blue nodular formations, sometimes ulcerated in the center, with a reddish granulomatous zone around the circumference. Sometimes sarcoid formations take the form of pseudopolysaccharide tissue, narrowing the lumen of the nasal passages and causing the formation of adhesions between the turbinates and the nasal septum. In this case, persistent rhinorrhea and frequent minor nosebleeds are observed.

The clinical course of sarcoidosis usually includes phases of exacerbation and remission. During an exacerbation of the disease, general weakness increases, myalgias and joint pains occur, ESR increases, leukopenia, lymphopenia and monocytosis develop. Hypercalcemia that occurs during exacerbations contributes to the appearance of thirst, polyuria, nausea and constipation. In the pulmonary form of sarcoidosis, the most serious complications are cardiopulmonary insufficiency, glaucoma, cataracts, etc.

The diagnosis of nasal sarcoidosis is established based on the absence of specific microbiota, characteristic morphological changes both in the nose and in other organs, and the clinical picture. Nasal sarcoidosis is differentiated from other granulomatosis. If sarcoidosis is suspected, an X-ray examination of the chest (enlarged mediastinal lymph nodes, pulmonary fibrosis), ultrasound of the abdominal organs, and a comprehensive blood test are mandatory.

Treatment of nasal sarcoidosis, despite all the numerous proposals (arsenic, bismuth, mercury, gold, tuberculosis antigen, antibiotics, ACTH, radiotherapy, etc.), has proven ineffective or brings only temporary improvement.

Currently, in the active phase of sarcoidosis, treatment consists of long-term (6 months or more) use of glucocorticoids per os or locally (for example, in case of damage to the nose or eyes). They are also prescribed for damage to the heart, lungs, nervous system and generalized form. In complex treatment, immunosuppressants, delagyl, vitamin E are also used. At the same time, symptomatic treatment is carried out, depending on the localization of sarcoidosis and the resulting syndrome (treatment of respiratory failure, decompensated pulmonary heart disease, excision of adhesions from the nasal cavity, surgical treatment of complications of sarcoidosis of the eyes, etc.).

The prognosis for life and ability to work is favorable with early treatment. Recovery is possible after the first course of hormonal therapy; many patients may experience long-term remissions. In the late stages of the disease, treatment is ineffective. Patients with stable cardiopulmonary insufficiency and damage to the nervous system are incapacitated, and their prognosis for life worsens. Patients with sarcoidosis are subject to dispensary observation in anti-tuberculosis institutions.

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