title: Cryptococcosis in sarcoidosis: cryptOsarc, a comparative study of 18 cases.
abstract: OBJECTIVE
  To describe the main characteristics and the treatment of cryptococcosis in patients with sarcoidosis.
  
  
  METHODS
  Multicenter study including all patients notified at the French National Reference Center for Invasive Mycoses and Antifungals.
  
  
  METHODS
  Retrospective chart review. Each case was compared with two controls without opportunistic infections.
  
  
  RESULTS
  Eighteen cases of cryptococcosis complicating sarcoidosis were analyzed (13 men and 5 women). With 2749 cases of cryptococcosis registered in France during the inclusion period of this study, sarcoidosis accounted for 0.6% of all the cryptococcosis patients and for 2.9% of the cryptococcosis HIV-seronegative patients. Cryptococcosis and sarcoidosis were diagnosed concomitantly in four cases; while sarcoidosis was previously known in 14/18 patients, including 12 patients (67%) treated with steroids. The median rate of CD4 T cells was 145 per mm(3) (range: 55-1300) and not related to steroid treatment. Thirteen patients had cryptococcal meningitis (72%), three osteoarticular (17%) and four disseminated infections (22%). Sixteen patients (89%) presented a complete response to antifungal therapy. After a mean follow-up of 6 years, no death was attributable to cryptococcosis. Extra-thoracic sarcoidosis and steroids were independent risk factors of cryptococcosis in a logistic regression model adjusted with the sex of the patients.
  
  
  CONCLUSIONS
  Cryptococcosis is a significant opportunistic infection during extra-thoracic sarcoidosis, which occurs in one-third of the cases in patients without any treatment; it is not associated to severe CD4 lymphocytopenia and has a good prognosis.
authors.affiliation: Department of Internal Medicine, 103 Grande Rue de la Croix-Rousse, 69317 Lyon Cedex 04, France. claire.bernard32@gmail.com
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mesh_terms: D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D018791:CD4 Lymphocyte Count; D003453:Cryptococcosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D008875:Middle Aged; D009894:Opportunistic Infections / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy / Q000276:immunology; D011379:Prognosis; D012189:Retrospective Studies; D012507:Sarcoidosis / Q000150:complications* / Q000188:drug therapy / Q000276:immunology; D055815:Young Adult
chemical_list: D000935:Antifungal Agents; D005938:Glucocorticoids; D007166:Immunosuppressive Agents