Endgames Case Review

Just a painful swelling of the ankles?

BMJ 2018; 360 doi: https://doi.org/10.1136/bmj.k436 (Published 09 March 2018) Cite this as: BMJ 2018;360:k436

Author's reply

Thank you for your comments. In our review we stated that the diagnosis of Lofgren syndrome is mainly done by clinical features and thus invasive diagnostic tests are usually not needed. Nevertheless our patient underwent a PET/CT scan as he was being unresponsive to the initial treatment. Hence this exam was performed not only to better assess inflammatory activity, identify occult extrathoracic disease, but maily to help exclude underlying disease other than sarcoidosis (eg, malignancy or infectious conditions).
An ultrasound of the ankles was also performed to identify/exclude synovitis as the presence of inflammatory signs of both ankles was the first and only clinical feature and the differential diagnosis would then be different (panniculitis vs arthritis).

Competing interests: No competing interests

13 March 2018
Gisela Eugénio