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Bilateral leg swelling as the presenting symptom of Löfgren syndrome in a paediatric patient: a rare presentation of a rare paediatric disease
  1. Bailey Komishke1,
  2. Jessica L Foulds2,
  3. Tamara McMillan3 and
  4. Nicholas Avdimiretz4
  1. 1Pediatrics, Stollery Children's Hospital, Edmonton, Alberta, Canada
  2. 2Pediatrics, University of Alberta Faculty of Medicine and Dentistry, Edmonton, Alberta, Canada
  3. 3Pediatric Rheumatology, Stollery Children's Hospital, Edmonton, Alberta, Canada
  4. 4Pediatric Respirology, Stollery Children's Hospital, Edmonton, Alberta, Canada
  1. Correspondence to Dr Nicholas Avdimiretz; naa1{at}ualberta.ca

Abstract

A 17-year-old previously healthy man presented with a 4-week history of progressive bilateral leg swelling with discomfort and erythema, but no signs of arthritis or erythema nodosum. An incidental finding of a query pulmonary nodule on chest X-ray prompted chest CT for further evaluation, revealing bilateral hilar and mediastinal lymphadenopathy. The patient then underwent endobronchial ultrasound and transbronchial needle aspiration biopsies of mediastinal lymph nodes. Biopsies and bronchoalveolar lavage samples were negative for microbiology, including mycobacterial culture. Pathology demonstrated non-caseating granulomas consistent with a diagnosis of sarcoidosis. Weeks later, he developed arthralgias of the left metacarpophalangeal joints and erythema nodosum and was diagnosed with Löfgren syndrome, a phenomenon rarely described in the paediatric population. This case highlights an approach to lower extremity swelling as well as hilar lymphadenopathy in the paediatric population. In addition, it emphasises the importance of multidisciplinary teamwork for accurate and timely diagnoses.

  • interstitial lung disease
  • rheumatology
  • paediatrics

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Footnotes

  • Contributors All authors have approved this manuscript. BK contributed to the literature review, information collection, drafting and editing of this case. JF contributed to the case’s conception, editing and submission. TM contributed to the case’s conception, literature review and editing. NA contributed to the conception, literature review, editing and submission of this case.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Parental/guardian consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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