Lofgren's Syndrome (Acute Sarcoid Arthritis)

58-year-old male, a retired bank employee, presented with a 3-week history of bilateral ankle pain and swelling. He also had an intermittent dry cough that would be continuous on lying down. Two painless red nodules developed recently on his left lower extremity. He had recent onset fatigue and lost 2 Kg weight during those three weeks. He was a known hypertensive on drugs for ten years and had skin and nail psoriasis for 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 the 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 the chest showed hilar prominence confirmed by a CT scan to be lymphadenopathy. He was treated with a 4-week tapering course of prednisolone and settled completely without any recurrence for the next three years. Association with psoriasis appears to be incidental and rarely reported.

Sarcoidosis is an inflammatory disorder affecting mainly the 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% of cases. Steroids and methotrexate form the mainstay of therapy.

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