Coexistence of Ankylosing Spondylitis and L？fgren’s Syndrome

A 46-year-old male patient diagnosed with ankylosing spondylitis presented to our polyclinic with complaints of pain, swelling, and limitation in joint mobility in both ankles and erythema nodosum skin lesions in both pretibial sites. The sacroiliac joint graphy and the MRI taken revealed active and chronic sacroiliitis. On the thorax CT, multiple mediastinal and hilar lymphadenopathies were reported. Mediastinoscopic excisional lymph node biopsy was taken and noncalcified granulomatous structures, lymphocytes, and histiocytes were determined on histopathological examination. The patients were diagnosed with ankylosing spondylitis, sarcoidosis, and L？fgren’s syndrome. NSAIDs, sulfasalazine, and low dose corticosteroid were started. Significant regression was seen in the patient’s subjective and laboratory assessments. 1. Introduction Sarcoidosis is a systemic disease characterized by the involvement of multiple tissues and organs and a noncalcified granulomatous reaction, which is not well understood [1]. L？fgren syndrome is an acute sarcoidosis presentation characterized by arthritis/arthralgia, erythema nodosum (EN), and bilateral hilar lymphadenopathy. Although its pathogenesis in not clear, there appears to be a cellular immune system activation and a nonspecific inflammatory response against some genetic and environmental factors [2]. Th1-lymphocyte and macrophages caused by proinflammatory cytokines induce the inflammatory cascade and the formations of granulomas occur as a result of tissue permeability, cellular influx, and local cell proliferation [3]. The indispensable pathological finding of sarcoidosis is noncalcified epitheloid cellular granulomas [4]. Different prevalence, clinical findings, and course of disease in different races and ethnic groups suggest that sarcoidosis is a heterogeneous disease [5]. The disease is more prevalent in women and develops after 40 years of age. Sarcoidosis is a chronic granulomatous disease that may present with different clinical findings. The disease most frequently presents with bilateral hilar lymphadenopathy, infiltrations in the lungs, and skin and eye lesions. It may mimic a number of primary rheumatic diseases (connective tissue diseases, vasculitis, and spondyloarthritis) and/or develop concomitantly to these [6]. Locomotor involvement is determined to be 15–25%. The sacroiliac joint involvement typical in ankylosing spondylitis (AS) is rarely observed in sarcoidosis. In this paper, we report a case of ankylosing spondylitis coexisting with L？fgren’s syndrome. 2. Case Report A 46-year-old male