Acute sarcoidosis: Löfgren's syndrome

Sarcoidosis and Its Dermatological Manifestations: A Narrative Review

Sarcoidosis is an enigma diagnosed by ruling out other etiologies of granulomatous inflammation. The multisystem manifestations of sarcoidosis and the clinical polymorphism pose a diagnostic challenge to all physicians. The skin is the most commonly affected organ after the lungs in sarcoidosis. Dermatological manifestations can appear before, during, or after systemic involvement, and the type of skin lesion can have prognostic significance. Also, a biopsy of skin lesions is less invasive and more accessible to perform than a biopsy of visceral organs. Thus, in certain ways, cutaneous manifestations can aid in the diagnosis and prognosis of systemic disease. This article has focused on the frequently encountered skin lesions of sarcoidosis along with their prevalence, clinical features, and management.

Diagnosis of Lofgren’s Syndrome and the Role of Ultrasound

We report the case of a 32-year-old woman presenting to the emergency department with ankle edema and arthralgia. Only later in the follow-up period, she developed erythema nodosum. The study revealed bilateral hilar and mediastinal lymphadenopathy and biopsy demonstrated non-caseating granulomas consistent with a diagnosis of Lofgren’s syndrome. Patients often do not present with all signs and symptoms, which delays the correct diagnosis. This case reinforces the need to use diagnostic methods, particularly non-invasive ones, such as ultrasound (US), in such cases. US of the lower extremity swelling could have helped the diagnosis, even without demonstrating effusion.

The Sudden Development of Multi-Organ Lesions in a Patient With Pulmonary Sarcoidosis: A Case Report

Introduction. Sarcoidosis is a systemic granulomatous inflammatory disease that can involve almost any organ system in the human body. It most frequently presents with pulmonary infiltrates, hilar lymphadenopathy, and skin lesions. Clinical and subclinical involvement of other organ systems is not uncommon. However, the simultaneous development of clinically apparent multisystem sarcoidosis is very rare. Case Description. This 44-year-old Caucasian man presented to an outpatient clinic with a 2-month history of fatigue, night sweats, weight loss, loss of appetite, and mild abdominal discomfort. Initial laboratory finding showed elevated liver enzymes. Imaging studies revealed cirrhotic liver with steatosis, few enhancing hepatic masses, and multiple enlarged periaortic and portocaval lymph nodes. Liver biopsy revealed scattered necrotizing granulomatous hepatitis. Positron emission tomography scan showed extensive hepatic uptake, diffuse lymphadenopathy, as well as numerous fluorodeoxyglucose-avid osseous lesions. After extensive workup to rule out malignancy and infectious etiologies, a diagnosis of diffuse multi-organ sarcoidosis was made. He was ultimately treated with methotrexate and steroids, resulting in marked improvement in symptoms and liver function, with stable disease on repeat imaging. Conclusion. Diffuse multi-organ sarcoidosis is often associated with widespread lymphadenopathy and osseous lesions, which appear indistinguishable from malignancy on imaging. The angiotensin converting enzyme levels and inflammatory markers may be normal. Clinicians should be aware of the possibility of diffuse systemic sarcoidosis in any patient with a remote sarcoidosis history and the simultaneous development of multi-organ–related symptoms.

Sternoclavicular joint arthritis as the initial presentation of sarcoidosis

Sarcoidosis is a multisystem granulomatous disease of unknown etiology. It can affect the musculoskeletal system in the form of acute and rarely, in the form of chronic peripheral arthritis involving bilateral small and large joints. Axial joint involvement with sarcoidosis is rare. Herein we report a case with sternoclavicular joint arthritis as the initial presentation of sarcoidosis. This report aims to demonstrate a rare initial presentation of sarcoidosis and highlight the importance of considering sarcoidosis as a differential diagnosis in patients presenting with sternoclavicular joint arthritis.