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

Sarcoidosis is a common disease affecting the reticulogistiocyte system, taking place in the forms from the lungs, which do not affect the general state of the organism, to severe disabling and even fatal forms. It is known under the name of Beck's disease or Bénier-Beck-Schaumann disease. It refers to systemic diseases with chronic course, characterized by the formation of specific granulomas in various organs and tissues. Sarcoid granulomas differ from tuberculosis mainly by the absence of necrotic changes. In the affected organs, the development of fibrosis, leading to a persistent impairment of the functions of the affected organs, is possible.

The cause of sarcoidosis is not fully understood. In the late 19 and first half of the XX century. This disease was associated with tuberculosis, but this hypothesis was not confirmed. Other "theories" of the aetiology of sarcoidosis, for example, the role of leprosy, syphilis, beryllium, microscopic fungi, viruses, etc., turned out to be unconvincing. According to modern ideas, sarcoidosis is a disease of impaired immunoreactivity with a special reaction of the organism to the influence of various environmental factors.

Pathological anatomy. The main morphological substrate of sarcoidosis is a tuberculoid granuloma resembling a tuberculous tubercle. The main element in the qualitative and quantitative aspect of this granuloma is the epithelioid cell. With a typical histological picture of sarcoidosis of the skin in the deep and middle parts of the dermis, isolated granulomas separated from the epidermis and from each other are found, consisting almost exclusively of epithelial cells with a narrow lymphoid-cell rim along the periphery without signs of curdled necrosis. Often in the sarcoid granuloma (unlike the tuberculous tubercle) blood vessels are found. Another of its cellular elements are giant cells like Langhans, which, unlike tuberculosis, are not always found in small numbers. An important differential diagnostic value is the absence in the sarcoid granuloma of an inflammatory zone of polymorphonuclear leukocytes. Sarcoidosis of the nose is manifested by the appearance on the skin of dense nodules of bluish color, the dissemination of which is periodic and can last for decades. These nodules tend to ulcerate with the formation of a granulation tissue along the circumference, in a small amount may arise their curdled necrosis, which shows their similarity with the nodules that occur with lupus and leprosy. When microscopy of the nasal mucosa, similar nodular formations of pale blue are found, sometimes infected in the center, with a reddish granulomatous zone along the circumference. Sometimes sarcoid formations take the form of a pseudolithic tissue narrowing the lumen of the nasal passages and is the cause of the formation of synechia between the nasal conchae and the septum of the nose. At the same time there is an ongoing rhinorrhea and frequent small nosebleeds.

In the clinical course of sarcoidosis, the phases of exacerbation and remission are usually observed. During the exacerbation of the disease, general weakness develops, myalgia, joint pain, increased ESR, leukopenia, lymphocytopenia and monocytosis develop. The hypercalcemia arising during exacerbations contributes to the appearance of thirst, polyuria, nausea and constipation. With the pulmonary form of sarcoidosis the most serious complications are cardiopulmonary insufficiency, glaucoma, cataract, etc.

The diagnosis of sarcoidosis of the nose is established on the basis of the absence of a specific microbiota, characteristic morphological changes both in the nose and in other organs, as well as the clinical picture. Differentiate sarcoidosis of the nose from other granulomatosis. If there is a suspicion of sarcoidosis, an x-ray examination of the breast (enlargement of the mediastinal lymph nodes, pulmonary fibrosis), ultrasound of the abdominal cavity organs, and a detailed blood test are mandatory.

Treatment of sarcoidosis of the nose, despite all the numerous suggestions (preparations of arsenic, bismuth, mercury, gold, tuberculosis antigen, antibiotics, ACTH, X-ray therapy, etc.), proved ineffective or bringing only temporary improvement.

Currently, in the active phase of capcoidosis, treatment consists of long-term (6 months or more) use of glucocorticoids per os or topically (for example, if the nose or eyes are affected). They are also prescribed for lesions of the heart, lungs, nervous system and generalized form. In complex treatment, immunosuppressants, deligil, and vitamin E are also used. Simultaneously, symptomatic treatment is performed, depending on the localization of sarcoidosis and the emerging syndrome (treatment of respiratory failure, decompensated pulmonary heart disease, excision of the sinus cavity from the nasal cavity, surgical treatment of complications of eye sarcoidosis, etc.). .

The prognosis for life and ability to work during treatment in the early stages is favorable. Possible recovery after the first course of hormone therapy; in a number of patients, long-term remissions are possible. In the late stages of the disease, treatment is not effective. Patients with stable cardiopulmonary insufficiency and nervous system damage are disabled, the prognosis for their life worsens. Patients with sarcoidosis are subject to dispensary supervision in anti-TB facilities.

[1], [2], [3], [4], [5]