title: Cryptococcal eosinophilic meningitis in a patient with sarcoidosis.
abstract: A 51-year-old African-American man with underlying pulmonary, hepatic and splenic sarcoidosis, reported a 3-day history of headache, neck stiffness and photophobia. He was not using medication for chronic sarcoidosis. Physical examination was significant for nuchal rigidity. Lumbar puncture revealed marked eosinophilia in the cerebrospinal fluid, which, on further analysis, demonstrated a positive cryptococcal antigen. HIV antibody and PCR tests were negative. Bronchoscopy and fungal blood cultures were also negative. The patient was started on amphotericin B and flucytosine, with significant clinical improvement. He recovered well without any neurological sequelae and remained symptom-free at 2-week follow-up. Cryptococcal central nervous infections are uniformly fatal if left untreated. Prompt diagnosis and treatment is essential, to prevent the associated high morbidity and mortality.
authors.affiliation: Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: Hiba
authors.identifier: http://orcid.org/0000-0001-9947-0480
authors.initials: H
authors.lastname: Hadid
authors.affiliation: Wayne State University, Detroit, Michigan, USA.
authors.forename: Paul
authors.initials: P
authors.lastname: Nona
authors.affiliation: Internal Medicine Department, Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Usman
authors.affiliation: Henry Ford Health System, Detroit, Michigan, USA.
authors.forename: David
authors.initials: D
authors.lastname: Paje
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D004802:Eosinophilia / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000382:microbiology*; D005437:Flucytosine / Q000627:therapeutic use; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000134:cerebrospinal fluid / Q000188:drug therapy / Q000382:microbiology*; D008875:Middle Aged; D009127:Muscle Rigidity; D012507:Sarcoidosis / Q000150:complications*; D013129:Spinal Puncture
chemical_list: D000935:Antifungal Agents; D000666:Amphotericin B; D005437:Flucytosine