Acute sarcoidosis/ Lofgren’s syndrome

A few weeks ago, a young patient (24yo) was admitted to our hospital  with complaints of bilateral ankle pain, swelling and redness or “periarthritis” for 1 day with no other systemic symptoms. 

On ankle exam, was found to have pain with active movements of the ankle but none with passive. +tenderness along posterior tibialis and peroneus tendons bilaterally.

Evaluation for a young patient with b/l peri-arthritis in as follows (as was done in our patient):

– CXR (to evaluate for sarcoidosis- he was found to have bilateral hilar lymphadenopathy)

– ANA, ALSO, urine GC Ag/PCR (negative)

– HIV screen/PPD (negative, PPD pending)

– other infectious work-up as indicated by history

He was diagnosed with Lofgren’s syndrome (triad of bilateral arthritis + hilar lymphadenopathy + erythema nodosum) even though he did not have the third component which is more common in females with Lofgren’s. Biopsy is NOT indicated for confirmation of the diagnosis.

Treatment: He was treated with NSAIDs, responded partially and then given SSKI (saturated solution of iodide). Steroid would be the next line.

Prognosis: Excellent for Lofgren’s with 95% resolution of symptoms by 2 years.

NEJM review article; Educational slides with patient’s images