Primary oral sarcoidosis preceding Lofgren's syndrome

Abstract

Sarcoidosis is a multisystem granulomatous disease of unknown origin that may affect any organ. It presents most frequently in bilateral hilar lymphadenopathy, pulmonary infiltration, and skin or eye lesions. The diagnosis is established if clinical and radiographic findings are supported by the characteristic histologic evidence of noncaseating epithelioid-cell granulomas. Moreover, bronchoalveolar lavage has achieved diagnostic relevance in this context. Lofgren’s syndrome is the early phase of acute systemic sarcoidosis, characterized by painful, walnutsized, subcutaneous, firm, tender nodules on both shins and around the knee and ankle joints (erythema nodosum), arthritis of the ankles, and a bilateral hilar lymphadenopathy. Oral lesions of sarcoidosis, unrelated to lymph node or salivary gland disease, have been reported infrequently. They have been described as nontender, well circumscribed nodules or papules, which are brownish red or violaceous in color and occasionally show superficial ulceration. Reported sites of oral involvement have included the lips, tongue, buccal mucosa, gingiva, hard and soft palate, and floor of the mouth. The maxillofacial skeleton can very rarely be involved We report a case of oral sarcoidosis as the first presenting sign of this disease preceding the establishment of Lofgren’s syndrome, indicating that there may be no systemic indication of sarcoidosis if the oral lesion is the initial presenting sign.