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Case Reports

Abstract

Löfgren’s syndrome is an acute manifestation of sarcoidosis seen in 5-10% of cases and is defined by a triad of acute arthritis, erythema nodosum, and bilateral hilar lymphadenopathy. Löfgren’s syndrome is a diagnosis of exclusion and is rarely reported in Hispanic populations. We describe a case of a 54-year-old Hispanic female who presented to the emergency department with a 1-month history of bilateral foot pain and a 10-day history of bilateral ankle erythema and edema. The physical exam was notable for tender subcutaneous nodules of the bilateral thighs, unilateral ankle, wrist, and elbow. Upon admission, chest CT revealed multiple enlarged mediastinal and hilar lymph nodes bilaterally and ground glass opacities of the left lower lung. Laboratory studies showed elevated CRP and ESR with negative ANA and RF. X-rays of the lower extremities showed no abnormalities. Infectious disease work-up was negative for hepatitis C, HIV, TB, syphilis, gonorrhea, and histoplasmosis. Dermatology was consulted and skin examination was notable for erythematous indurated plaques, pitting edema, and tenderness to palpation of the feet and ankles bilaterally. A punch biopsy of the right ankle revealed granulomatous septal panniculitis suggestive of erythema nodosum. Tissue culture grew no fungal, aerobic, or anaerobic organisms. The presence of bilateral hilar lymphadenopathy, acute symmetric polyarthritis, and histopathologic findings of erythema nodosum was suggestive of Löfgren’s syndrome. Diagnosis was confirmed with the presence of granulomas on transbronchial lymph node biopsy. Our case highlights the crucial role of dermatopathological examination in revealing the skin manifestations of systemic diseases.