title: Acute-onset sarcoidosis with erythema nodosum and polyarthralgia (Löfgren's syndrome) in Japan: a case report and a review of the literature.
abstract: Löfgren's syndrome is an acute form of sarcoidosis that is characterized by erythema nodosum (EN), bilateral hilar lymphadenopathy (BHL), and polyarthralgia or polyarthritis. This syndrome is common among white people, but is considered rare among Japanese people. We present the case of a 26-year-old Japanese woman with Löfgren's syndrome. The patient complained of polyarthritis and EN of the lower extremities that lasted for 3 months. A chest radiograph revealed BHL and nodular shadows. The angiotensin-converting enzyme (ACE) level was within the normal range. Transbronchial lung biopsy revealed a noncaseating granuloma with giant cells. Six Japanese cases of Löfgren's syndrome have been reported previously. Five of the seven Japanese patients with Löfgren's syndrome had normal ACE levels; all of them exhibited BHL. Löfgren's syndrome should be considered as a possibility when examining a patient with EN and articular symptoms, even if the patient is Japanese.
authors.affiliation: Department of Respiratory Oncology and Molecular Medicine, Institute of Development, Aging, and Cancer, Tohoku University, Sendai.
authors.forename: Hiromitsu
authors.initials: H
authors.lastname: Ohta
authors.forename: Ryushi
authors.initials: R
authors.lastname: Tazawa
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nakamura
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Kimura
authors.forename: Makoto
authors.initials: M
authors.lastname: Maemondo
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Kikuchi
authors.forename: Masahito
authors.initials: M
authors.lastname: Ebina
authors.forename: Toshihiro
authors.initials: T
authors.lastname: Nukiwa
mesh_terms: D000328:Adult; D018771:Arthralgia / Q000150:complications* / Q000208:ethnology; D044466:Asian People; D001999:Bronchoscopy; D004893:Erythema Nodosum / Q000150:complications* / Q000208:ethnology; D005260:Female; D006099:Granuloma / Q000150:complications / Q000473:pathology; D006801:Humans; D008171:Lung Diseases / Q000150:complications / Q000473:pathology; D008206:Lymphatic Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000208:ethnology; D013902:Radiography, Thoracic; D012507:Sarcoidosis / Q000150:complications* / Q000208:ethnology; D013577:Syndrome