Background
Lofgren's syndrome
Triad of
- Bilateral Hilar Lymphadenopathy (BHL)
- Acute polyarthritis
- Erythema nodosum
Clinical
Symptoms
- Respiratory (cough, SOB, wheeze, chest pain)
- Low energy, Joint pains
Examination
- Respiratory exam. (plus arthritis, low grade pyrexia)
Investigations
- Regular PFTs
- initial ↓ CO diffusion capacity
- later restrictive pattern
- CXR
- Lymphopenia, ↑Ca++, ↑ACE levels
Scadding classif. Pulmonary Involvement
Stage 0: Normal CXR
Stage 1: BHL
Stage 2: BHL & parenchymal changes
Stage 3: Parenchymal infiltration (no BHL)
Stage 4: Lung fibrosis
Management
Therapy (immunosuppression, Steroids, MTX, Azothioprine) indications
- Hypercalcaemia
- Cardiac involvement
- Neurological
- Eye involvement (Ant. & Post. uveitis, optic neuritis retinal vasculitis, conjunctivitis)
- Eye involvement in 20% of all cases. Late complications incl. cataract, glaucoma
- Heerfordt's synd. = ant. uveitis, parotitis, facial palsy, fever
- Progressive pulmonary disease