Fifty Shades of Sarcoidosis: A Case Report of Löfgren Syndrome

INTRODUCTION Sarcoidosis is a multi-organ disorder that is characterized by the presence of noncaseating granulomas in involved organs. It commonly affects young and middle-aged individuals of all races, but is 3-4 times more common in African Americans and typically presents earlier with more severe symptoms.1 The lungs are affected in 90% of patients and pulmonary disease accounts for the majority of the morbidity and mortality associated with this disease. However, approximately 30% of patients can present with extrapulmonary findings and can have involvement of other organs such as the skin and eyes.1 The various presentations of sarcoidosis can make it challenging to diagnose and can lead to delays in treatment. Therefore, it is important for clinicians to recognize the wide variety of manifestations of sarcoidosis. In this case report, we present a case of sarcoidosis in a young man with arthralgias and skin lesions. KEY POINTS Common organs affected in sarcoidosis include the lungs, skin and eyes. Extrapulmonary sarcoidosis can manifest as Löfgren syndrome which is a constellation of symptoms and objective findings including hilar lymphadenopathy, migratory polyarthralgia, and fever with or without erythema nodosum. Diagnosis of sarcoidosis is made from a combination of symptoms, radiologic findings, evidence of noncaseating granulomas in involved organs and exclusion of other known causes of granulomatous inflammation. Standard treatment of sarcoidosis is prednisone 20-40 mg/day that is tapered every 4-12 weeks and follow-up with a rheumatologist or pulmonologist. If symptoms reoccur, maintenance therapy with prednisone 10-15 mg/day can be continued for 3-6 months. In cutaneous disease, topical high-potency steroids, methotrexate or hydroxychloroquine can be used