Online consultations with MCSC doctors n. a. A. S. Loginov

Multidisciplinary approach in the diagnosis and treatment of diseases in the MCSC. The patient's history.

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The patient D. at the age of 64 years turned to the MCSC named after A. S. Loginov. She complained about:

  • difficulty swallowing solid and liquid food;
  • nausea;
  • burp air;
  • periodic pain in the epigastric region, regardless of food intake.

During the examination, the doctors paid attention to the results of the studies:

  • Radiography of the upper digestive tract with barium. It was found that the patient has a congenital short esophagus.
  • EGDS results. The forming stricture of the lower part of the esophagus.

The patient was prescribed a course of medications-proton pump inhibitors in combination with prokinetics. The therapy was followed by a good response, her condition improved, all the negative symptoms disappeared.

After the end of the prescribed therapy, the patient again felt worse and the complaints resumed in full. Due to the ineffectiveness of treatment, specialists prescribed her esophageal manometry, which showed motor disorders. At the same time, uncharacteristic symptoms of esophageal diseases attracted attention:

  • whiteness and blueness of the fingers in the cold;
  • shortness of breath with minor physical exertion.

A consultation with the Center's rheumatologist was scheduled. During the examination, it was revealed:

  • telangiectasia: dilated capillaries and venules with characteristic localization on the fingers, palms and face (Fig. 1)
  • sclerodactyly: local thickening and compaction of the skin of the fingers;
  • Raynaud's syndrome: a spastic reaction of the finger arteries and skin vessels when exposed to cold or emotional stress, characterized by a sequential change in the color of the skin of the fingers in white, then in blue-purple color (Fig. 2);
  • reduction of the mouth aperture: narrowing of the mouth opening with the formation of deep wrinkles around it (Fig. 3).
  • Specialists of the Center suggested that the patient has an autoimmune connective tissue disease-systemic scleroderma. To clarify the diagnosis, she was hospitalized in the Department of rheumatology.

The comprehensive survey included:

  • computed tomography of the chest cavity organs;
  • spirometry;
  • radiography of the upper digestive tract;
  • Ultrasound of the abdominal cavity and kidneys;
  • EGDS;
  • Echocardiography;
  • electroneuromyography;
  • immunological blood test.

The results revealed changes characteristic of systemic scleroderma

CT scan of the thoracic cavity

fibrotic changes in the lower parts of both lungs

Immunological blood test   

deviation of indicators

On the basis of complaints, the result of the examination, the conducted clinical and laboratory studies, the patient was diagnosed:

Systemic scleroderma, chronic course, moderate activity, limited form with damage to the skin, blood vessels and esophagus. 

The woman was prescribed anti-inflammatory drugs and a course of vascular therapy. Within 3 months, she strictly followed the doctor's recommendations and felt an improvement in her health. The shortness of breath disappeared, and the digestive disorders became less pronounced. She was recommended to continue therapy in full.

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GBUZ Moscow Clinical Scientific Center named after Loginov MHD