Cardiac Involvement in Löfgren Syndrome

Diagnosis and Evaluation

The American Thoracic Society guidelines suggest that Löfgren syndrome is characterized by bilateral hilar lymphadenopathy, erythema nodosum, and/or periarticular arthritis, and is usually associated with a good prognosis 1, 2, 3, 4, 5, 6
Bilateral hilar lymphadenopathy (on chest X-ray, CT, or PET) is a diagnostic criterion for Löfgren syndrome 1, 2, 3, 4, 5, 6
Erythema nodosum and/or periarticular arthritis are also diagnostic criteria for Löfgren syndrome 1, 2, 3, 4, 5, 6
If the classic triad is present, the diagnosis is considered "highly likely" according to the American Thoracic Society guidelines 1, 2

An abnormal EKG + cardiac symptoms (including tachycardia) combination increases the risk of cardiac sarcoidosis to 27.5% 7
If abnormal EKG findings are present, cardiac MRI, PET, or gallium scintigraphy should be used to evaluate inflammatory activity in the heart 1, 2, 3, 4, 5, 6
Reduced left ventricular ejection fraction without risk factors is considered a "possible" finding 1, 2, 3, 4, 5, 6
Ventricular tachycardia without risk factors is considered a "possible" finding 1, 2, 3, 4, 5, 6

Atrio-ventricular block, cardiomyopathy, and treatment-responsive AV node block are considered "possible" signs of cardiac involvement 1, 2, 3, 4, 5, 6

Löfgren syndrome usually has a self-limited course and excellent prognosis, but if atypical features (such as uveitis) are present, a more comprehensive evaluation is required 1, 2

The American Thoracic Society guideline considers the diagnosis "highly likely" when the classic triad of Löfgren syndrome is present, and a biopsy is usually not required 8
According to the American Thoracic Society guideline, uveitis is listed as a "possible" finding for sarcoidosis in the "physical examination" category, but it is not included in the "highly likely" characteristics of Löfgren syndrome 8

The development of uveitis in a patient with Löfgren syndrome may suggest a deviation from the typical benign course of the disease, and may indicate more aggressive systemic sarcoidosis 8