Lofgren's syndrome

Etiology

• associated with acute sarcoidosis

Pathology

• arthritis is non-destructive periarthritis of soft tissue, entheses & tenosynovium around joint,

Clinical manifestations

• erythema nodosum*
• symmetric bilateral hilar lymphadenopathy*
• acute arthralgias/polyarthritis* usually involving the ankles
• fever

* triad of acute sarcoidosis (Lofgren's syndrome), 95% specificity, further diagnostic tests unnecessary

Diagnostic procedures

• 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

Management

• observation: tissue diagnosis not needed
• NSAIDs may be used initially
• prednisone 10 mg BID (20 mg/day) for 3-4 weeks
• prognosis is good
  • > 80% of patients have spontaneous resolution

Notes

• distinnguish from Loffler's syndrome

More general terms

• sarcoidosis
• syndrome

Additional terms

• Loffler's syndrome (simple pulmonary eosinophilia)