Necrotic sarcoid granulomatosis

　　The etiology of NSG is unknown. Some reports suggest that fungal fragments are found in the granulomas of this disease, suggesting that it may be a variant type of exogenous allergic inflammation.

　　Necrotizing sarcoid granulomatosis shows pulmonary small nodular lesions, with a less extensive distribution and less necrosis than Wegener's granulomatosis. The histological manifestations include:

　　1. Merging non-caseating granulomatous pneumonia.

　　2. Necrosis, which can be quite extensive.

　　3. Vasculitis, so-called 'sarcoid-like granuloma' refers to the rounded aggregation of epithelioid tissue cells, with Langhans giant cells and lymphocytes scattered among them. Granulomas fuse to form small nodules in the lung parenchyma. The lung infiltration is similar to sarcoidosis, and the granuloma lesions are distributed in the pleura, bronchovascular bundle, and interlobar septum. The fused granulomas often invade the pleura. Necrosis is of varying sizes, from less extensive central necrotic foci to large areas of infarctive necrosis. Muscular arteries and veins are involved in vasculitis, which can have three morphologies, namely necrotizing granuloma, giant cell vasculitis, and mononuclear infiltration (including lymphocytes and macrophages). The ischemic necrosis of NSG is due to vasculitis causing luminal obstruction.

　　Common complications of necrotizing sarcoid granulomatosis:

　　1. Recurrent infections such as pneumonia, empyema, lung abscess, enteritis, and colitis, which can lead to anal fistula. It is common in liver, spleen, lung, and bone abscesses, and fungal abscesses in the brain. Esophagus, small intestine, and ureter can also cause obstruction.

　　2. Rhinitis, gastric antrum stenosis, chronic diarrhea, delayed development in children, often leading to short stature, and complications such as lupus erythematosus and juvenile rheumatoid arthritis.

　　Cough is a common symptom in necrotizing sarcoid granulomatosis, other symptoms include fever, chest pain, dyspnea, discomfort, and weight loss. The onset of symptoms is related to widespread lung infiltration or small nodules. 15% to 25% of patients are asymptomatic. The involvement of extrapulmonary organs is rare in this disease, but there are reports that 13% of patients have extrapulmonary symptoms, including eyes, brain and peripheral nerves, skeletal muscles, and digestive tract.

　　Early diagnosis, understanding the infection situation, making clinical observations, early detection of damage to various systems, early treatment, mainly controlling infection.

　　1. Strengthen nutrition and enhance physical fitness.

　　2. Prevent and control infections, and improve the body's immune function.

　　3. Avoid wind, cold, and dampness, avoid overexertion, avoid smoking and drinking, and avoid spicy foods.

　　4. Prognosis: The prognosis of the disease is good, and some asymptomatic patients have not been treated, and no progression of lesions has been found during follow-up. For patients with severe symptoms or progressive lesions, corticosteroid treatment can be given, which is effective. For those with disease progression or recurrence after hormone treatment, or those who develop intolerable adverse reactions during hormone treatment, immunosuppressants can be added, such as cyclophosphamide and busulfan, but there are currently few related reports.

　　Pathological examination is the main basis for diagnosing necrotizing sarcoid granulomatosis, with common X-ray changes including diffuse bilateral or unilateral small nodules or infiltrations in the lungs, about 1/3 of patients only present as solitary unilateral small nodules, and sometimes lung infiltrations with cavitation can be seen. Typical NSG hilar lymph node enlargement is uncommon, but it has also been reported to be seen in 79% of patients.

　　Dietary attention for patients with necrotizing sarcoid granulomatosis:

　　1. Diet should be light. Drink clear drinks or soups or teas, such as meat soup, juice, tea, etc., and sip slowly after cooling.

　　2. Eat more fresh fruits and vegetables.

　　3. Drink more tea or light beverages.

　　4. Avoid alcohol, chili, ginger, garlic, cinnamon, and other spicy foods.

　　5. Avoid smoking.

　　6. Do not eat too hot or too cold food.

　　7. Avoid greasy, smoked, or fried foods.

　　Limited lesions of necrotizing sarcoid granulomatosis can be cured by surgical treatment. Effective treatment with corticosteroids is applied to patients with diffuse lesions or other surgical indications. A few patients have persistent lesions or recurrence on X-ray, and can be treated with busulfan. Generally speaking, immunosuppressants should be used as little as possible.

　　Because necrotizing sarcoid granulomatosis itself rarely causes death, and most deaths are attributed to opportunistic infections.