When nuisance is nice: ignored erythema nodosa heralding the Löfgren's syndrome in a Nigerian woman

Löfgren's syndrome (LS) is a variant of sarcoidosis characterised by the triad of erythema nodosum (EN), radiographic bilateral hilar adenopathy, and arthralgia/arthritis. Like all cases of sarcoidosis, it is of unknown aetiology and may constitute a diagnostic difficulty in the ambiguous phenotype. Löfgren's syndrome is associated with a good prognosis and commonly undergoes spontaneous remission within four months. However, the co-existence of multiple good and adverse prognostic factors in a patient may call for guarded expectation. Sarcoidosis is generally more prevalent among people of African descent, but the vast majority of the literature on sarcoidosis are from the western hemisphere. Löfgren's syndrome has been rarely documented in West Africans despite the availability of some reports of sarcoidosis in the region. We present a case of a Nigerian woman with LS that started out as isolated EN, which was ignored for months until the onset of florid pulmonary and systemic symptoms.