DIFFERENTIAL DIAGNOSIS CHALLENGES OF PULMONARY SARCOIDOSIS IN PRIMARY CARE PRACTICE: THE ROLE OF MULTIDISCIPLINARY AND PERSONALIZED APPROACHES.

INTRODUCTION: Sarcoidosis remains one of the most difficult to diagnose granulomatous diseases due to the absence of pathognomonic symptoms and the need to exclude tuberculosis and oncopathology. In the context of primary health care (PHC), diagnostic errors reach 32%, which necessitates the optimization of diagnostic algorithms. OBJECTIVE: To substantiate the need for a multidisciplinary, personalized and differentiated approach to the diagnosis of pulmonary sarcoidosis in primary health care (PHC) using the example of a clinical case. CASE PRESENTATION: The analysis of a clinical case of a 54-year-old patient with comorbid pathology, who had respiratory and systemic manifestations for 6 months, is presented. The data of radiation (radiography, CT, PET/CT), laboratory and morphological studies, including repeated expert review of histological preparations, were evaluated. The initial treatment of the patient revealed a peripheral formation of the lower lobe of the left lung according to CT data. Negative cancer markers excluded the cancer process. A video thoracoscopic biopsy of the lungs and lymph nodes, as well as the detection of acid-resistant mycobacteria (KUM+), served as the basis for an erroneous diagnosis of tuberculosis. The lack of response to TB treatment for 3 months and the PET/CT data confirmed the need for a multidisciplinary consultation. Repeated expert review of histological preparations verified the diagnosis of pulmonary sarcoidosis, and subsequently, significant clinical and radiological regression was achieved against the background of glucocorticosteroid therapy. CONCLUSION: The presented clinical case demonstrates the fundamental complexity of the differential diagnosis of the classical course of sarcoidosis, tuberculosis and oncological diseases in a patient with comorbid pathology, which necessitates the use of multidisciplinary tactics and personalized analysis in primary health care.