Cutaneous findings should be actively sought in suspected cases of sepsis, as some of them (such as ecthyma gangrenosum) may provide clues about the infectious agent involved and the patient's immunosuppression status.
We report the case of a 32-year-old woman presenting to the emergency department with ankle edema and arthralgia. Only later in the follow-up period, she developed erythema nodosum. The study revealed bilateral hilar and mediastinal lymphadenopathy and biopsy demonstrated non-caseating granulomas consistent with a diagnosis of Lofgren's syndrome. Patients often do not present with all signs and symptoms, which delays the correct diagnosis. This case reinforces the need to use diagnostic methods, particularly non-invasive ones, such as ultrasound (US), in such cases. US of the lower extremity swelling could have helped the diagnosis, even without demonstrating effusion.
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