A Profound Vitamin B12 Deficiency in a Patient with Lofgren's Syndrome

Area of Science:

• Internal Medicine
• Pulmonology
• Gastroenterology

Background:

• Lofgren's syndrome is a distinct clinical presentation of sarcoidosis.
• It typically involves erythema nodosum, bilateral hilar lymphadenopathy, and migratory polyarthritis.
• Gastrointestinal involvement in sarcoidosis is uncommon but can lead to nutritional deficiencies.

Observation:

• A 57-year-old male presented with symptoms of Lofgren's syndrome, including polyarthritis, erythema nodosum, leg edema, and fever.
• Laboratory tests revealed anemia and severe vitamin B12 deficiency.
• Imaging confirmed bilateral hilar adenopathy, and pathology showed non-necrotizing granulomas consistent with sarcoidosis.

Findings:

• The patient's condition improved with prednisone and vitamin B12 supplementation.
• This case suggests a potential rare gastrointestinal manifestation of sarcoidosis contributing to vitamin B12 deficiency in Lofgren's syndrome.
• While GI biopsy was not performed, the clinical presentation and response to treatment support this hypothesis.

Implications:

• Vitamin B12 deficiency should be considered in patients presenting with Lofgren's syndrome, especially with gastrointestinal symptoms.
• Early diagnosis and management of nutritional deficiencies are crucial for sarcoidosis patients.
• This case underscores the diverse extrapulmonary manifestations of sarcoidosis.