Sarcoidosis presenting as Lofgran’s syndrome

A 40 year old male, first presented with erythema nodosum, fever, weight loss and joint pains and did not respond to anti-tubercular treatment. One year later he came back with joint pains, erythema nodosum, fever and dry cough. He also had weakness in distal right lower limb more than left limb. He had raised ESR, hypocalcaemia, raised ACE levels and lymphnode involvement on HRCT, with skin biopsy suggestive of sarcoidosis. This time patient responded to treatment and is on regular follow up.

The anti-synthetase syndrome in a type 1 diabetes

Anti-synthetase syndrome is an autoimmune disease associated with interstitial lung disease (ILD), dermatomyositis and polymyositis. It has been recognized as an important cause of autoimmune inflammatory myopathy in a subset of patients with dermatomyositis. 37-year-old male, known case of type 1 diabetes mellitus, came with complaints of: generalized anasarca, pain in both knees, ankles, wrist and small joints of fingers. He also had dyspnoea on exertion, chronic non-productive cough, and fever off and on, all for 1 month. Initially all involvement was attributed to diabetes. For joint pain an antinuclear antibodies (ANA) was sent. He turned out to be anti-Jo1, antibody positive. Rash on hands was diagnosed by dermatologist as, mechanic’s hand, hence diagnosed as an inflammatory myopathy with dermatomyositis anti-synthetase syndrome. Patient was successfully treated with immunosuppressants and supportive treatment and responded to tablet Prednisolone and Mycophenolate mofetil. The patient had one major and 2 minor criteria-ILD, arthritis and Mechanic’s hand and anti-Jo 1 antibody positive. Thus, diagnosed as anti-synthetase syndrome with type 1 diabetes mellitus.