RESUMEN
Sarcoidosis is an autoimmune multisystemic granulomatous disease with an unknown etiology. Löfgren syndrome (LS), an infrequent initial presentation of acute sarcoidosis, is characterized by the classic triad of acute arthritis, erythema nodosum (EN), and bilateral hilar lymphadenopathy (BHL). The presence of this triad offers high diagnostic specificity for sarcoidosis, eliminating the need for a confirmatory biopsy. Typically, LS follows a predictable, self-limiting clinical course. However, atypical presentations require early suspicion and closer monitoring. This case report highlights an unusual clinical manifestation of LS, marked by an incomplete presentation with acute panniculitis and joint lesions in the absence of EN. Acute sarcoidosis should be considered among the differential diagnoses when these clinical manifestations are present, and chest radiography should be performed to rule out BHL. In atypical cases, the disease course becomes less predictable, as exemplified in our case, where recurrence of the disease may occur, necessitating consistent monitoring.
RESUMEN
Löfgren syndrome is an acute presentation of sarcoidosis that comprises fever, bilateral and symmetric hilar lymphadenopathies, polyarthritis, and erythema. We present the case of a 34-year-old male patient who presented with ankle monoarthritis without a history of a traumatic event. Contralateral ankle arthritis associated with erythema nodosum and fever developed one week later. Laboratory tests showed anemia, thrombocytosis, and elevated inflammatory parameters. A chest CT revealed symmetrical mediastinal and hilar adenopathies. A transbronchial biopsy was compatible with granulomatous lymphadenitis, and the diagnosis of Löfgren syndrome was confirmed. Our case report and literature review emphasize the wide web of mimicry of acute sarcoidosis. Secondary forms of acute sarcoidosis are likely to benefit from additional and more complex immunomodulatory therapies. Close monitoring and follow-up should be conducted because it is possible that these patients experience higher rates of recurrence or relapse.
RESUMEN
Sarcoidosis is a multisystem granulomatous disorder that is characterized histologically by noncaseating granulomas. Typically, it presents clinically in young adults with initially one or more of the following: hilar lymphadenopathy, pulmonary reticular opacities, and skin, joint, and/or eye lesion. Radiographic findings commonly include bilateral hilar and mediastinal lymphadenopathy and pulmonary reticular opacities but may resemble pneumonia with airspace consolidation and opacities. We report a case of sarcoidosis that presented as a persistent case of pneumonia. This case is a reminder that common diseases such as pneumonia are not always what they seem, and diseases such as sarcoidosis that have specific characteristics may not present traditionally each time.
RESUMEN
We report the case of a 40-year-old man presenting at the emergency department with ankle and feet edema due to acute sarcoidosis (Lofgren syndrome). The diagnosis was suggested based on an ultrasound examination showing bilateral asymmetrical tenosynovitis of the flexor tendons with hypervascular subcutaneous cellulitis without any significant ankle and foot joint effusion or synovitis. This case report highlights the crucial role of ultrasound imaging as the first-line diagnostic tool in the investigation of a non-specific clinical condition, when performed by a knowledgeable sonographer with attention to detail. Radiologists performing ultrasound should be aware of the presenting ultrasound pattern of acute soft tissue sarcoidosis, and should include this entity in the differential diagnosis of patients with distal lower extremity swelling, tenosynovitis and hypervascular subcutaneous cellulitis, in order to narrow down the differential diagnosis and facilitate the clinical workup of the patient.