Acute sarcoid arthritis in Lofgren's syndrome.

Q: 52-year-old male is admitted to ICU with severe joint pain, fever, and hypovolemia. Patient resuscitated and started on antibiotics. The patient is seen by various services and went through various tests.  The final diagnosis was acute sarcoid arthritis. Which joint is mostly involved in acute sarcoid arthritis and may pinpoint towards diagnosis early in the course?

A) Knee
B) Shoulder
C) Wrist
D) Ankle
E) Pelvic


Answer:   D 

Acute sarcoid arthritis is a part of a triad in Lofgren's syndrome. The triad is consist  of 

• hilar adenopathy, 
• acute arthritis, and 
• erythema nodosum

Lofgren's syndrome is mostly self-limiting and seen in less than ten percent of sarcoidosis. Erythema nodosum is usually absent in male patients and can perplex clinicians.


References:

1. Abril A, Cohen MD. Rheumatologic manifestations of sarcoidosis. Curr Opin Rheumatol 2004; 16:51. 

2. Grunewald J, Eklund A. Sex-specific manifestations of Löfgren's syndrome. Am J Respir Crit Care Med 2007; 175:40.