A Profound Vitamin B12 Deficiency in a Patient with Lofgren’s Syndrome

Daniella Vronsky*, Amit Finkelstein, Shachaf Shiber, Moshe Heching, Noa Eliakim-Raz, Irit Ayalon-Dangur

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review


Lofgren’s syndrome is a unique manifestation of sarcoidosis presenting with erythema nodosum, bilateral hilar lymphadenopathy and migratory polyarthritis. A concurrent vitamin B12 deficiency is not well described and may be related to a rare gastrointestinal manifestation of sarcoid and Lofgren’s syndrome. We describe a case of a 57-year-old male presented with migratory polyarthritis, erythemic nodules, edema of his legs and fever. His laboratory tests showed anemia with a profound vitamin B12 deficiency. Imaging demonstrated bilateral hilar adenopathy. Pathology revealed non-necrotizing granulomas consistent with sarcoidosis. The patient was started on prednisone and vitamin B12 supplements with improvement of his complaints and vitamin B12 levels. Sarcoidosis can manifest in many extrapulmonary organs, including the gastrointestinal tract, resulting in nutritional deficiencies, such as vitamin B12 deficiency. Treatment of these nutritional deficiencies includes treatment with steroids, as well as vitamin supplementation. We suggest this case to be a rare manifestation of gastrointestinal involvement in Lofgren syndrome; however, a biopsy from the GI tract was not performed to confirm the diagnosis. An informed consent was obtained from the patient. An institutional approval was not required for the publication of this case.

Original languageEnglish
Pages (from-to)655-658
Number of pages4
JournalInternational Medical Case Reports Journal
StatePublished - 2023


  • Lofgren’s syndrome
  • gastrointestinal tract
  • sarcoidosis
  • vitamin B12


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