Löfgren Syndrome with Hypercalcemia and Neuroendocrinological Involvement: A Case Report.

Sarcoidosis is a systemic inflammatory disease of unknown etiology that can affect virtually any organ. Löfgren syndrome, characterized by erythema nodosum, hilar lymphadenopathy, fever and polyarthritis, represents only 20-30% of cases of sarcoidosis. Only 2-10% of cases feature hypercalcemia. We present the case of a 42 year old Hispanic woman with past history of erythema nodosum who presented with 3 weeks of nausea, emesis, constipation, asthenia, adynamia, polydipsia, and somnolence, concomitant with hypercalcemia, but normal parathyroid hormone (PTH) and 25-hydroxyvitamin D. Initial diagnostic approach was based on the suspicion of multiple myeloma or bone metastases; however, further findings of bilateral hilar lymphadenopathy, elevated serum angiotensin-converting enzyme (ACE) and a right inguinal lymphadenomegaly suggested an alternate cause. Biopsy of the latter supported sarcoidosis as the diagnosis. She was successfully managed in hospital with zoledronic acid and as an outpatient with immunosuppressive therapy. Persistence of a previously undisclosed symptom of oligomenorrhea lead to the finding of hyperprolactinemia secondary to an hypophyseal infiltration, refractory to immunosuppressive therapy but with an adequate response to cabergoline. This case presents a straying from the typical pattern of Löfgren Syndrome, presenting a more progressive, multisystemic behaviour.