Mikulich disease (Sjogren's disease) is a fairly rare chronic disease that manifests itself in a parallel increase in all salivary and lacrimal glands and their further hypertrophy.
Главными факторами, лежащими в основе его development, are a viral infection, blood diseases, allergic and autoimmune processes, disorders in the functioning of the lymphatic system. There is such a disease only in adults, mainly in women. It was first described by the German surgeon I. Mikulic in 1892. Now they believe that the enlargement of the glands is not an independent disease, but a concomitant syndrome with various violations of the endocrine system.
Scientists still have not figured out the exact reasons underlying Mikulich's illness. Only hypothetical grounds are proposed, for example:
Autoimmune disease;
· The first stage of development of a malignant tumor;
· Disruption of the hematopoietic system;
· Tuberculosis;
· Syphilis;
· Mumps (epidemic parotitis);
· Epidemic encephalitis.
Pervasive lesion of organs and systems of the bodyviolates the neurovegetative regulation of the tear and salivary glands, changes their secretory function. Autoimmune or allergic reactions contribute to clogging out the gland ducts with eosinophilic stoppers, delay secretion, cut the channels of smooth muscle and myoepithelial cells. As a result, interstitial and lymphoid tissues expand, squeeze the ducts and lead to an ever-increasing hypertrophy of the salivary and tear glands. Let's look at the symptoms of Mikulich's disease.
Most often the disease appears in the age periodfrom 20 to 30 years. Elderly people suffer less often, in children it was not fixed. In the first stages, the symptoms are similar to those of chronic mumps, in addition, if inflammatory complications occur, it can be provoked.
The first and most important symptom of Mikulich's disease -swelling of the lacrimal glands. Gradually they become painful when pressed, and in some cases so increase in size that under their weight the eyeball descends and even protrudes forward. Although the consistency of the glands is rather dense, suppuration is not observed.
The second symptom is an increase in the salivary glands(submandibular, parotid, less frequently hyoid). Usually this process is bilateral, swelling occurs on both sides, and only in exceptional cases - with one. Often there is an increase in lymph nodes.
The third symptom is complaints of dry mouth, dryconjunctivitis and multiple dental caries. In the case of a typical course of the disease, the liver and spleen increase, leukemia and lymphocytosis are observed.
Disease Mikulich diagnosed by doctors from the generalclinical picture. Often a sialogram is made, which reveals dystrophic changes in the glandular tissue, which clearly shows an increase in the salivary glands, a narrowing of their outflow ducts. If they are not affected, it is necessary to carefully examine the lymphomas of the orbit.
A wide application is also found in puncturehistopsy biopsies. Histologically, hyperplasia of the tear and salivary glands can be detected, atrophic modification of the parenchyma and the presence of lymphoid infiltration of the stroma.
High efficiency for diagnosing and developing a treatment regimen have parallel studies of blood around the lymph nodes and an analysis of bone marrow puncture.
It should be noted that during the illness of Mikulich(the treatment of which we shall consider below) the glandular capsule is not affected, therefore the tissues of the salivary and glandular glands do not combine with the mucous membranes and skin, thanks to this factor it is possible to distinguish this syndrome from various kinds of productive chronic inflammations.
Laboratory blood tests show a picture that characterizes lymphoproliferative diseases, and the results of urinalysis usually do not reveal any pathologies.
With the help of computer tomography, it is possible to more accurately determine the structure and size of salivary glands, to exclude the appearance of malignant neoplasms.
Diagnosis of the disease includesimmunochemical and immunological examination with examination of an allergologist-immunologist, as well as consultation of an ophthalmologist, performance of the Schirmer test and sampling with fluorescein.
Treatment of Mikulich's disease should take place undersupervision of a hematologist. The main means - preparations of arsenic, most often a solution of sodium arsenate in 1% concentration. It is used for subcutaneous injections, starting at 0.2 milliliters and gradually increasing the dosage to 1 milliliter once a day. By the end of treatment, the dose decreases. Approximately 20-30 injections are required for complete therapy. In the same doses, the drug "Duplex" is used. Two to three times a day the patient is given potassium arsenate for ingestion. The course of treatment lasts about three to four weeks. You can also drink arsenic tablets, use dopane and myelosan.
Compresses are widely applied to the affected glandsand antibiotics. In addition to drug therapy, blood transfusions are also used. In some cases, the achievement of positive dynamics becomes possible due to X-ray therapy, which ensures the stopping of the inflammatory process and the temporary decrease in the size of the glands, the restoration of their secretory function, and the elimination of dry mouth. The general strengthening of the body contributes to the intake of vitamins.
We examined the features of the disease and Mikulich syndrome.
