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Lofgren's syndrome

Etiology: - associated with acute sarcoidosis Pathology: - arthritis is non-destructive periarthritis of soft tissue, entheses & tenosynovium around joint, Clinical manifestations: 1) erythema nodosum* 2) symmetric bilateral hilar lymphadenopathy* 3) acute arthralgias/polyarthritis* usually involving the ankles 4) fever * triad of acute sarcoidosis (Lofgren's syndrome), 95% specificity, further diagnostic tests unnecessary Special laboratory: - bronchoscopy or mediastinoscopy with lymph node biopsy to rule out/in lymphoma if asymmetric mediastinal lymphadenopathy is noted on chest x-ray Radiology: - chest X-ray: bilateral hilar lymphadenopathy Differential diagnosis: - tuberculosis* - lymphoma* * triad of arthralgia, erythema nodosum & hilar lymphadenopathy is rare [4] Management: 1) observation: tissue diagnosis not needed [2,3] 2) NSAIDs may be used initially 3) prednisone 10 mg BID (20 mg/day) for 3-4 weeks 4) prognosis is good - > 80% of patients have spontaneous resolution Notes: - distinnguish from Loffler's syndrome

Related

Loffler's syndrome (simple pulmonary eosinophilia)

General

sarcoidosis syndrome

References

  1. Mayo Internal Medicine Board Review, 1998-99, Prakash UBS (ed) Lippincott-Raven, Philadelphia, 1998, pg 172
  2. Medical Knowledge Self Assessment Program (MKSAP) 11,15,16,17,18,19. American College of Physicians, Philadelphia 1998,2009,2012, 2015, 2018, 2022
  3. Hamzeh N. Sarcoidosis. Med Clin North Am. 2011 Nov;95(6):1223-34 PMID: 22032436
  4. NEJM Knowledge+ Rheumatology - Saltman AP, Kuriya B Lofgren syndrome in acute sarcoidosis. CMAJ. 2017 Oct 2;189(39):E1230 PMID: 28970261 PMCID: PMC5628035 DOI: Free PMC article