SHM Converge Scientific Abstract ePoster Gallery-A Case of Lofgren's Syndrome With Atypical Skin Lesions

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This case describes a 40-year-old Hispanic man with heart failure, hypothyroidism, and pre-diabetes who was hospitalized for a painful, warm, itchy rash on his extremities, upper-limb swelling, and inflammatory joint pain and stiffness involving the elbows, knees, ankles, wrists, and back. On exam, he had tender, pink, warm, indurated plaques with poorly defined borders on both forearms and legs. The rash was atypical for erythema nodosum because it was pruritic, larger than usual, and extended beyond the shins.<br /><br />Workup showed elevated inflammatory markers and procalcitonin. ACE level was normal. CT angiography revealed bilateral hilar and mediastinal lymphadenopathy with left lower lobe peribronchial consolidation, raising concern for sarcoidosis, specifically Lofgren’s syndrome. Because the skin findings were atypical and the differential included panniculitis and cellulitis, a skin biopsy was performed and confirmed erythema nodosum. Infectious testing was negative for tuberculosis, though histoplasma and chlamydia IgG antibodies were elevated, initially complicating the picture.<br /><br />The overall clinical picture—erythema nodosum, inflammatory arthritis with ankle involvement, and hilar adenopathy—supported Lofgren’s syndrome, an acute sarcoidosis subtype. The patient did not improve with NSAIDs but responded well to prednisone 20 mg daily, with significant improvement in rash and ankle pain within two weeks. This response lowered concern for active histoplasma or chlamydia infection.<br /><br />The report emphasizes that sarcoidosis is a multisystem granulomatous disease and that Lofgren’s syndrome typically has an acute, self-limited course with a favorable prognosis. It also highlights that erythema nodosum can present atypically, making clinical suspicion and exclusion of mimics essential. In some cases, the classic triad can be sufficiently specific to guide diagnosis and treatment without invasive testing.

Asset Subtitle

Narmada Lavu

Meta Tag

Author List Joseph Nahas, Narmada Lavu

Category Clinical Vignettes

Concept Löfgren Syndrome

Concept Erythema nodosum

Concept Hilar lymphadenopathy

Concept Bilateral ankle arthritis

Concept Sarcoidosis

Distinguished Non-Finalist

Presenter Organization Creighton University

Presenting Author Narmada Lavu

Track Adult

Keywords

Lofgren syndrome

sarcoidosis

erythema nodosum

hilar lymphadenopathy

inflammatory arthritis

panniculitis

prednisone

skin biopsy

ankle swelling

granulomatous disease

Löfgren Syndrome

Erythema nodosum

Hilar lymphadenopathy

Bilateral ankle arthritis

Sarcoidosis