SHM Converge Scientific Abstract ePoster Gallery-Avoiding the Lofty Workup: A Case Series on Acute Sarcoidosis

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This case series highlights two hospitalized patients with acute sarcoidosis, specifically Löfgren syndrome (LS), a clinical diagnosis characterized by fever, erythema nodosum, bilateral hilar adenopathy, and symmetric polyarthritis, especially involving the ankles.<br /><br />Case 1 describes a 49-year-old man with two weeks of painful bilateral ankle swelling, chest pain, cough, and fever. Initial evaluation, including labs and venous ultrasound, was unrevealing, and he was briefly treated for suspected cellulitis with antibiotics. Chest x-ray and CT instead showed bilateral hilar and mediastinal adenopathy with pulmonary nodules, supporting sarcoidosis. ACE level was elevated and IGRA was negative. He was discharged with naproxen and pulmonary follow-up.<br /><br />Case 2 involves a 35-year-old man with one week of fevers, severe bilateral joint pain, and a painful nodular rash on the extremities. He had already received amoxicillin for presumed cellulitis without improvement. Inflammatory markers were high, chest imaging showed bilateral hilar and mediastinal lymphadenopathy, and infectious testing including IGRA was negative. Skin biopsy confirmed erythema nodosum, supporting LS. Because symptoms were severe and NSAIDs were insufficient, he improved dramatically after prednisone and was discharged with a taper.<br /><br />The discussion emphasizes that LS often mimics cellulitis or infectious arthritis, leading to unnecessary antibiotic use and extensive inpatient workups. However, when the classic clinical and imaging features are present, diagnosis is highly specific and biopsy is not required. Most patients improve with NSAIDs alone; corticosteroids may be used for refractory symptoms. Pulmonary tuberculosis should be excluded, and ophthalmology screening for uveitis should be considered. Early recognition can shorten hospital stays and reduce invasive testing.

Asset Subtitle

Prashanth Moku

Meta Tag

Author List Bridget B. Hottenstein, Prashanth Moku, Tammy Yu

Category Clinical Vignettes

Concept Löfgren Syndrome

Concept Erythema nodosum

Concept Hilar lymphadenopathy

Concept Fever

Concept Polyarthritis

Distinguished Non-Finalist

Presenter Organization Brown University Internal Medicine Residency Program

Presenting Author Prashanth Moku

Track Adult

Keywords

Löfgren syndrome

acute sarcoidosis

erythema nodosum

bilateral hilar adenopathy

symmetric polyarthritis

ankle swelling

mediastinal lymphadenopathy

prednisone treatment

NSAIDs

cellulitis mimic

Löfgren Syndrome

Erythema nodosum

Hilar lymphadenopathy

Fever

Polyarthritis