Lofgren's Syndrome (Acute Sarcoid Arthritis)
Lofgrens - Psoriasis Lofgrens A58 year old male, a retired bank employee, presented with 3 week history of bilateral ankle pain and swelling. He also had Lofgrens B Lofgrens Hilar Nodesintermittent dry cough that would be continuous on lying down. 2 painless red nodules developed recently on his left lower extremity. He had recent onset fatigue and lost 2 Kg weight during those 3 weeks. He was a known hypertensive on drugs since 10 years and had skin and nail psoriasis since 34 years. Clinical examination revealed synovitis of both ankles and wrists. He had skin and nail psoriasis along with discrete lesions of erythema nodosum on legs and right hand. A few inspiratory crackles could be auscultated on respiratory examination. ESR was 57 mm at one hour, Rheumatoid factor 57 IU and Serum ACE normal. Other laboratory investigations were normal. His X-ray of chest showed hilar prominence confirmed by CT scan to be lymphadenopathy. He was treated with a 4 week tapering course of prednisolone and settled completely without any recurrence for next 3 years. Association with psoriasis appears to be incidental and rarely reported.
Sarcoidosis is an inflammatory disorder affecting mainly lungs and lymph nodes. Small inflammatory nodules appear at various sites. It can involve multiple systems including joints, bones, eyes, muscles, liver, spleen and bone marrow. The disease can be mild and asymptomatic to debilitating and lead to death in less than 5% cases. Steroids and methotrexate form mainstay of therapy at present.

Lofgrens - Psoriasis Lofgrens ALofgren's - Psoriasis
Lofgren's A 

Lofgrens B Lofgrens Hilar NodesLofgren's B
Lofgren's Hilar Nodes

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