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September 29, 2016

Dr. Ahmad Iqbal Mirza   |   AKUH, Karachi

A Patient with Cough, Fever & Joint pain

A 59-year-old woman presented with a 2 months history of a dry cough and a 1-month history of low-grade fever, arthralgia and pretibial nodules that were red and painful. Physical examination confirmed a temperature of 38.4°C, severe bilateral ankle periarthritis and prominent erythema nodosum affecting the lower anterior shins and forearms around the elbows. Chest imaging revealed bilateral hilar adenopathy.
Differential Diagnosis?

  1. Systemic lupus erythematosus
  2. Rheumatoid arthritis
  3. Sarcoidosis
  4. Lymphoma

 

 Erythema Nodosum

rehuma-fact

 

Investigation on Summary :

rehuma-one_edited

 

Discussion :

The answer is  sarcoidosis. We diagnosed a variant of sarcoidosis known as Löfgren’s syndrome based on the patient’s history of malaise, low-grade fever, bilateral ankle periarthritis, erythema nodosum and abnormal chest imaging. The patient received a short course of prednisone and colchicine therapy. Her symptoms completely resolved within 6 months and she was still disease-free after 2 years.

Löfgren’s syndrome is characterized by a combination of erythema nodosum, fever, hilar adenopathy and migrating polyarthritis mostly affecting the ankle joints. The condition tends to be transient, usually remitting after 3 – 4 months, with or without analgesic, anti-inflammatory therapy.