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Sarcoidosis with acute recurrent polyarthritis and hypercalcemia
Takeo Sato1, Tsunehisa Tsuru, Kiyofumi Hagiwara
1Department of Allergy and Rheumatology, Japanese Red Cross Medical Center, Tokyo.
Internal Medicine (Tokyo, Japan)
|April 18, 2006
Summary
This case study highlights a patient with sarcoidosis presenting atypical arthritis symptoms without bilateral hilar lymphadenopathy. Early diagnosis and prednisolone treatment led to successful management of this inflammatory condition.
Area of Science:
- Rheumatology
- Pulmonology
- Ophthalmology
Background:
- Sarcoidosis is a multisystem inflammatory disease characterized by non-caseating granulomas.
- Löfgren's syndrome, a subtype of sarcoidosis, typically presents with acute arthritis, erythema nodosum, and bilateral hilar lymphadenopathy.
- Atypical presentations of sarcoidosis can pose diagnostic challenges.
Observation:
- A 45-year-old woman experienced recurrent fever, arthritis (knees and ankles), and anterior uveitis.
- Initial investigations revealed increased serum lysozyme but lacked bilateral hilar lymphadenopathy.
- Serum calcium and angiotensin-converting enzyme levels progressively rose, supporting a sarcoidosis diagnosis.
Findings:
- The patient's arthritis mimicked Löfgren's syndrome, despite the absence of erythema nodosum and bilateral hilar lymphadenopathy.
- Elevated serum calcium and angiotensin-converting enzyme levels were key diagnostic indicators.
- The case demonstrates a variant presentation of sarcoidosis.
Implications:
- This case underscores the importance of considering sarcoidosis in patients with unexplained arthritis and uveitis, even without classic radiographic findings.
- Recognizing atypical sarcoidosis presentations is crucial for timely and appropriate treatment.
- Prompt treatment with corticosteroids, such as prednisolone, can effectively manage sarcoidosis symptoms.
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