Lofgren’s syndrome: A case report and review of the literature

Lofgren's syndrome is a variant of acute-onset sarcoidosis, characterized as Hilar Lymphadenopathy (HL), Erythema Nodosum (EN) and bilateral arthritis or arthralgia, with elevated serum Angiotensin Converting Enzyme (ACE) and calcium level. It is relatively common in Caucasians, but rarely reported in Asian countries. We reported a 72-year old Chinese female with HL, acute onset EN, multiple arthritis and arthralgia, and achieved remission with prednisolone treatment. We summarized reported cases in European and Asia countries, and investigated the characteristics of etiology, genetics, prognosis and therapeutic strategy variants due to different ethnicities. Almost all the patients showed HL, and half of them exhibited classical triad. ACE, the biomarker of Lofgren's syndrome, elevated in more than half of the European cases, but only 30% in Asian patients. NASID is considered as the first choice of Lofgren's syndrome, and glucocorticoid may be necessary in severe cases. One quarter of the cases from European countries need steroid therapy. However, the proportion is much higher (64.3%) to achieve symptomatic relief. Considering Lofgren's syndrome is rare and less recognized from sarcoidosis in Asian patients, further investigation is needed to achieve clinical experience.