Arthralgia in a Young Patient: Presentation of Lofgren Syndrome

Abstract

1Department of Medicine, 2Department of Orthopedics, Khyber Teaching Hospital, Peshawar-Pakistan Lofgren syndrome an acute form of sarcoidosis constitutes erythema nodosum, bilateral hilar adenopathy and arthralgia or arthritis. Here we present a case of a 28 years old young male patient who is a shopkeeper and farmer by profession admitted to inpatient department with chief complaints of bilateral painful nodules on his shins, low grade fever and pain multiple joints on both sides of the body. Suspicion of the Lofgren syndrome was made upon initial evaluation and patient was admitted to inpatient care facility for necessary comprehensive workup. Radiological findings were consistent with bilateral hilar lymphadenopathy and patient was diagnosed with Lofgren syndrome. Patient was started on non-steroidal inflammatory drugs (NSAIDs) with close observation for improvement in response to treatment. After one weak of treatment in hospital, patient was discharged home when his symptoms started to resolve.

Tolerable upper intake level for dietary sugars

“…The change was driven by hypercholesterolaemic participants.Jin et al (2014) 9/6F 12/4F OW NAFLD P, 4 c: Fructose i: Glucose 20 20 Beverages NSD: Bw NSD: Liver fat ↓ Adipose tissue IR index 9 NSD: FG, FI, HOMA‐IR ↓ VLDL NSD: TG Sugar type had no effect on body weight, liver fat or triglycerides. Adipose tissue IR and VLDL decreased with glucose vs. fructoseMaersk et al (2012)* 15/11F 16/11F 15/12F 14/6F OW/Obese P, 24 c1: SK milk c2: Water c3: ASSD i: SSSD 0 0 0 18 Beverages NSD: Bw, BMI, BF, LBM ↑ Liver fat ↑ VAT ↑ SKm fat (data available for 47 subjects) NSD: FG, FI, HOMA‐IR; glucose and insulin responses (AUC) and derived indices of IR on OGTT ↑ SBP (c1, c3) NSD: DBP ↑ T‐c (vs c3) ↑ TG (vs c2 and c3) NSD: LDL‐c, HDL‐c, T‐c/HDL‐c ratio ↑ FUA (data available for 47 subjects) Consumption of SSSD increased triglycerides, uric acid and ectopic fat deposition with no effect on body weight, total body fat or glucose homeostasisMajid et al (2013) 31 M 32 M GP P, 4 c: No drink i: Honey 0 8 Beverages↓ FG ↓ T‐c, LDL‐c, TG ↑ HDL‐c Honey consumption limited the rise in blood glucose and improved the blood lipid profile. Background diet and changes in body weight were not assessed.Mark et al (2014) 35F 38F OW/OB P, 4 i: Fructose 10 c: Glucose 10 15 15 Beverages NSD: BW, BMI, WC NSD: FG, FI, HOMA‐IR; glucose and insulin responses and ISI on OGTT NSD: T‐c, LDL‐c, HDL‐c, TG…”

“…The amount of sugars provided with the intervention always refers to added sugars, except for studies using honey (free sugars, Majid et al (2013)), studies which targeted non-milk extrinsic sugars (free sugars, Markey et al (2016); Umpleby et al (2017)) or a whole liquid diet (total sugars as free sugars, Thompson et al (1978)).…”

Influences of sex chromosome aneuploidy on height, weight, and body mass index in human childhood and adolescence

“…The SCD effects on height and weight reported here also carry broader relevance for clinical research in SCAs. In particular height covaries with many other body systems, including the size and output of the heart (Jørgensen et al, 2015; Salzano et al, 2016), volume and capacity of the lungs (Bhatti et al, 2014; Cook & Hamann, 1961; Hepper et al, 1960), metabolism (Cole & Henry, 2005), bone density (Chen et al, 2019), brain volume (Warling et al, 2020), and venous thromboembolism (Berry et al, 2023; Salzano et al, 2016; Zöller et al, 2016), which are all important to consider from a clinical perspective. More research on the longitudinal effects of aneuploidy on these features that also incorporate information on body growth will be important.…”

“…Many SCAs are associated with changes in diverse aspects of biological structure and function like metabolism, endocrine function, cardiac function, and brain anatomy (Chen et al, 2013; Salzano et al, 2016; Tartaglia et al, 2020; Warling et al, 2020). Variations in body size present an important context for understanding these changes because several of the phenotypes involved vary with human body size in health (Berry et al, 2023; Bhatti et al, 2014; Chen et al, 2019; Cole & Henry, 2005; Cook & Hamann, 1961; Hepper et al, 1960; Jørgensen et al, 2015; Reardon et al, 2018; Salzano et al, 2016; Warling et al, 2020; Zöller et al, 2016), and it has been well established that SCAs are themselves associated with changes in body size (Counts et al, 2021; Oetjens et al, 2019; Ottesen et al, 2010). Specifically, a nonlinear association between height and sex chromosome dosage has been previously described by Ottesen et al (Ottesen et al, 2010).…”