title: Löfgren's syndrome revisited: a study of 186 patients.
abstract: OBJECTIVE
  To evaluate the clinical features, the results of noninvasive tests and biopsies, and the outcome of patients with Löfgren's syndrome.
  
  
  METHODS
  Patients diagnosed as having Löfgren's syndrome at a university hospital in Barcelona, Spain, from 1974 to 1996, were prospectively followed. Löfgren's syndrome was defined as the association of erythema nodosum or periarticular ankle inflammation with unilateral or bilateral hilar or right paratracheal lymphadenopathy.
  
  
  RESULTS
  Löfgren's syndrome was diagnosed in 186 patients. The mean age was 37 +/- 11 years, and 157 (85%) were women. In 91 patients (49%), symptoms started during the spring (P < 0.0001). Erythema nodosum, periarticular ankle inflammation, or both were present at onset in 173 patients (93%). At the time of diagnosis, 161 patients (87%) had no respiratory symptoms; 151 (81%) had stage I abnormalities on chest radiograph, 29 (16%) stage II, and 6 (3%) stage 0. Five percent of patients had decreased forced vital capacity, and 15% had decreased carbon monoxide diffusing capacity. Extrathoracic involvement was infrequent. Serum angiotensin-converting enzyme levels were increased in 50% of patients. Gallium-67 scans showed hilar uptake in all the studied patients, but it yielded useful additional diagnostic information only in those with normal chest radiographs or with unilateral hilar lymphadenopathy. The diagnosis was proven with biopsy results in 63% of patients. None of the patients without histologic confirmation were subsequently found to have a diagnosis other than sarcoidosis. In the 133 patients who were followed for a mean of almost 5 years, 11 (8%) continued to have active disease, and 8 (6%) had several recurrences between 18 months and 20 years after a complete resolution. A normal serum angiotensin-converting enzyme level at diagnosis was associated with disease resolution without recurrence.
  
  
  CONCLUSIONS
  Löfgren's syndrome is usually a self-limiting form of sarcoidosis. Histologic confirmation is not necessary in typical cases. In a small number of patients, the disease may remain active or recur long after its onset, although usually with mild organ dysfunction.
authors.affiliation: Internal Medicine Service, Ciutat Sanitària i Universitària de Bellvitge, University of Barcelona, Spain.
authors.forename: J
authors.initials: J
authors.lastname: Mañá
authors.forename: C
authors.initials: C
authors.lastname: Gómez-Vaquero
authors.forename: A
authors.initials: A
authors.lastname: Montero
authors.forename: A
authors.initials: A
authors.lastname: Salazar
authors.forename: J
authors.initials: J
authors.lastname: Marcoval
authors.forename: J
authors.initials: J
authors.lastname: Valverde
authors.forename: F
authors.initials: F
authors.lastname: Manresa
authors.forename: R
authors.initials: R
authors.lastname: Pujol
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000843:Ankle Joint; D001168:Arthritis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D001706:Biopsy; D003937:Diagnosis, Differential; D004893:Erythema Nodosum / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D005260:Female; D005710:Gallium Radioisotopes; D006801:Humans; D008206:Lymphatic Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D008875:Middle Aged; D007703:Peptidyl-Dipeptidase A / Q000097:blood; D011446:Prospective Studies; D011859:Radiography; D012008:Recurrence; D012129:Respiratory Function Tests; D012507:Sarcoidosis / Q000175:diagnosis; D013577:Syndrome
chemical_list: D005710:Gallium Radioisotopes; D007703:Peptidyl-Dipeptidase A