Triad of Löfgren's syndrome.

Q: In female patients who get diagnosed with Löfgren syndrome, which is more common? - select one

A) Eerythema nodosum 

B) Ankle arthropathy

Answer: A

Löfgren syndrome is a triad of sarcoidosis with

• acute-onset fever
• hilar adenopathy, 
• erythema nodosum or bilateral ankle inflammation

Interestingly, erythema nodosum or bilateral ankle inflammation strikes differently in males and females. Löfgren syndrome is more common in females with variable proportions of erythema nodosum. Males are more prone to ankle arthropathy. It may also affect knees, wrists, or elbow joints. 

The presence of Löfgren syndrome has a high diagnostic specificity for sarcoidosis. As they can also be present in acute tuberculosis and acute presentations of endemic fungal infections, including histoplasmosis, blastomycosis, and coccidioidosis, they should be ruled out.

#rheumatology

References:

1. Judson MA. The Clinical Features of Sarcoidosis: A Comprehensive Review. Clin Rev Allergy Immunol 2015; 49:63.

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

3. Statement on sarcoidosis. Joint Statement of the American Thoracic Society (ATS), the European Respiratory Society (ERS) and the World Association of Sarcoidosis and Other Granulomatous Disorders (WASOG) adopted by the ATS Board of Directors and by the ERS Executive Committee, February 1999. Am J Respir Crit Care Med 1999; 160:736.

4. Saha BK, Chong W, Bonnier A, Wallace S. Löfgren Syndrome in Histoplasma Endemic Rural America. Am J Med Sci 2020; 360:419.