Lofgren syndrome
Lofgren syndrome is a triad of acute arthritis/periarthritis, erythema nodosum, and bilateral hilar adenopathy in a patient with sarcoidosis. This can be associated with fever and uveitis (6%). Joint involvement most commonly presents as an arthritis and/or periarthritis of the ankles. The acute arthritis is usually self-limited and resolves within weeks but may persist for months (average 3 months). Nonsteroidal antiinflammatory drugs are recommended initially, but low-dose corticosteroids may be clinically necessary to manage if severe symptoms exist. The ACE level is elevated in less than half of the cases. However, those with an elevated ACE level are more likely to have recurrence or persistence of the arthritis. Overall, these patients have a >90% remission rate. Acute histoplasmosis may simulate Lofgren syndrome and must be excluded by serologies, urine antigen, and cultures.
