The patient was a 46-year-old man who had consulted a physician for pyrexia and arthralgia. As he developed neuropathy, he was referred to our department for detailed examination to facilitate a definitive diagnosis and treatment. Enlarged mediastinal and hilar lymph nodes were noted, and endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) was performed. Biopsy revealed the presence of a non-caseating epithelioid cell granulomas, leading to a diagnosis of sarcoidosis. Finally, the patient was diagnosed with Löfgren's syndrome (variant form) because he presented with arthralgia, but not erythema nodosum, and we diagnosed the neuropathy as small fiber neuropathy.
Löfgren's syndrome accounts for 20%–30% of sarcoidosis cases in Scandinavia, and approximately 70% of the patients are female. A literature search using the Japan Medical Abstracts Society's Ichushi revealed that only eight of the 37 patients with Löfgren's syndrome in Japan were male. The findings of this case and previously reported cases suggest that male patients commonly present with a variant form of Löfgren's syndrome without erythema nodosum and with pyrexia.