Donghi M, Giura R, Antonelli P
Pulmonary Division of S. Anna Hospital, Como, Italy.
Sarcoidosis. 1995 Sep;12(2):147-9.
Chest X ray showing bilateral hilar adenopathies of the mediastinum associated with erythema nodosum suggests the diagnosis of Löfgren syndrome rather than the presence of a lymphoproliferative disorder. However, the occasional finding of high serum levels of copper can induce diagnostic doubts since serum copper increase is an index of lymphoproliferative disorders, particularly of Hodgkin's disease. We observed four patients with Löfgren syndrome presenting with fever, arthralgies, bilateral hilar adenopathies of the mediastinum and erythema nodosum. All patients underwent whole staging for sarcoidosis and serum copper levels were measured. In all cases clinical and instrumental data allowed the diagnosis of sarcoidosis and in all the patients we found high levels of serum copper with an average of 34.8 mumol/L (30.7-39.4) at the onset of the disease. Three months later, the sarcoid process spontaneously remitted and the serum copper levels returned to normal range. Although the finding of an increase of serum copper in patients with mediastinal adenopathies is usually indicative of a lymphoproliferative disorder (Hodgkin's disease), our data suggest that its increase can be related also to non neoplastic adenopathies of the mediastinum, including sarcoidosis.
胸部X光显示双侧纵隔肺门淋巴结肿大并伴有结节性红斑提示诊断为 Löfgren 综合征而非存在淋巴增殖性疾病。然而，偶尔发现血清铜水平升高会引发诊断疑问，因为血清铜升高是淋巴增殖性疾病尤其是霍奇金病的一个指标。我们观察了 4 例患有 Löfgren 综合征的患者，他们表现为发热、关节痛、双侧纵隔肺门淋巴结肿大和结节性红斑。所有患者均接受了结节病的全面分期检查并检测了血清铜水平。在所有病例中，临床和影像学数据均支持结节病的诊断，并且在所有患者中我们发现疾病发作时血清铜水平升高，平均为 34.8 μmol/L（30.7 - 39.4）。三个月后，结节病进程自发缓解，血清铜水平恢复到正常范围。虽然纵隔淋巴结肿大患者血清铜升高的发现通常提示淋巴增殖性疾病（霍奇金病），但我们的数据表明其升高也可能与纵隔的非肿瘤性淋巴结肿大有关，包括结节病。
