title: Cryptococcal meningitis complicating sarcoidosis.
abstract: BACKGROUND
  Cryptococcal meningitis is an uncommon but severe complication of sarcoidosis.
  
  
  METHODS
  We present 2 patients with cryptococcal meningitis complicating sarcoidosis and compared findings with 38 cases reported in the literature.
  
  
  RESULTS
  When analyzing our patients and 38 cases reported in the literature, we found that median age of sarcoidosis patients with cryptococcal meningitis was 39 years (range 30-48); 27 of 33 reported cases (82%) had a history of sarcoidosis. Only 16 of 40 patients (40%) received immunomodulating therapy at the time of diagnosis of cryptococcal meningitis. The diagnosis of cryptococcal meningitis was delayed in 17 of 40 patients (43%), mainly because of the initial suspicion of neurosarcoidosis. Cerebrospinal fluid (CSF) examination showed mildly elevated white blood cell count (range 23-129/mm). Twenty-nine of 32 cases (91%) had a positive CSF culture for Cryptococcus neoformans and 25 of 27 cases (93%) had a positive CSF C neoformans antigen test. CD4 counts were low in all patients in whom counts were performed (84-228/mL). Twelve patients had an unfavorable outcome (32%), of which 7 died (19%) and 24 patients (65%) had a favorable outcome. The rate of unfavorable outcome in patients with a delayed diagnosis was 7 of 17 (41%) compared to 5 of 28 (21%) in patients in whom diagnosis was not delayed.
  
  
  CONCLUSIONS
  Cryptococcal meningitis is a rare but life-threatening complication of sarcoidosis. Patients were often initially misdiagnosed as neurosarcoidosis, which resulted in considerable treatment delay and worse outcome. CSF cryptococcal antigen tests are advised in patients with sarcoidosis and meningitis.
authors: Department of Neurology, Academic Medical Center, Center of Infection and Immunity Amsterdam (CINIMA), Amsterdam, the Netherlands.
authors: Sonja E
authors: SE
authors: Leonhard
authors: Daan
authors: D
authors: Fritz
authors: Diederik
authors: D
authors: van de Beek
authors: Matthijs C
authors: MC
authors: Brouwer
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000000981:diagnostic imaging / Q000473:pathology; D008206:Lymphatic Diseases / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D016919:Meningitis, Cryptococcal / Q000150:complications* / Q000175:diagnosis; D008875:Middle Aged; D012507:Sarcoidosis / Q000150:complications* / Q000000981:diagnostic imaging / Q000473:pathology; D017565:Sarcoidosis, Pulmonary / Q000150:complications