Niimi Takashi, Sato Shigeki, Sugiura Yoshiki, Akita Kenji, Maeda Hiroyoshi, Ninomiya Shigemitsu, Achiwa Hiroyuki, Masui Sonoko, Bessho Yuji, Maeno Ken, Naniwa Taio, Kotsuka Masanori, Morishita Munehiko, Ueda Ryuzo
Department of Internal Medicine and Molecular Science, Nagoya City University Graduate School of Medical Science, Nagoya, Japan.
Nihon Kokyuki Gakkai Zasshi. 2003 Mar;41(3):207-10.
Rheumatoid arthritis was diagnosed in a 30-year-old woman with erythema nodosum and arthritic symptoms since 1994, and she was treated with anti-rheumatic agents. Mediastinal and bilateral hilar lymphadenopathy and abnormal pulmonary shadows were detected in 1996, and she was admitted to our hospital in 1997. We also recognized the elevation of ACE and lysozyme, and found granulomas in a transbronchial lung biopsy and an arthrosis synovia biopsy. From these findings, sarcoidosis was diagnosed. Sarcoidosis demonstrating erythema nodosum, arthritis, and bilateral hilar lymphadenopathy is called Löfgren's syndrome. In Caucasians, Löfgren's syndrome is frequently encountered, but it is rare in Japanese. Our case had coexisting arthrosis symptoms, and satisfied the diagnosis criteria of rheumatic arthritis. Therefore, the differential diagnosis was important. We emphasize that it is necessary to consider Löfgren's syndrome when diagnosing patients with rheumatic features, even in Japan.
一名30岁女性自1994年起出现结节性红斑和关节炎症状，被诊断为类风湿关节炎，并接受了抗风湿药物治疗。1996年发现纵隔及双侧肺门淋巴结肿大和肺部异常阴影，1997年入住我院。我们还发现血管紧张素转换酶（ACE）和溶菌酶升高，并在经支气管肺活检和关节滑膜活检中发现肉芽肿。根据这些发现，诊断为结节病。表现为结节性红斑、关节炎和双侧肺门淋巴结肿大的结节病称为 Löfgren 综合征。在白种人中，Löfgren 综合征较为常见，但在日本人中很少见。我们的病例同时存在关节症状，符合类风湿关节炎的诊断标准。因此，鉴别诊断很重要。我们强调，即使在日本，在诊断有风湿特征的患者时也有必要考虑 Löfgren 综合征。
