Cryptococcal eosinophilic meningitis in a patient with sarcoidosis

Abstract

SUMMARYA 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. BACKGROUND

Case Report: Cryptococcal eosinophilic meningitis in a patient with Hodgkin lymphoma

“…As mentioned above, only four cases have been reported in the past 30 years ( Table 1 ). All patients had a significant medical history: one patient had been submitted to thymectomy and combined irradiation and chemotherapy; one patient had had angioimmunoblastic T-cell lymphoma; one patient had asthma, perennial rhinitis, atopic dermatitis and high-dose steroid therapy; the other patient had sarcoidosis ( 8 – 11 ). The initial proportion of eosinophils in CSF of three patients was 50, 12, and 76%, respectively; exact data is not available for the other patient.…”

“…EM caused by cryptococcal meningitis is rare. To our knowledge, only four cases have been reported in the past 30 years ( 8 – 11 ). A proportion of eosinophils as high as 91% presented in this case has not been reported, and such a high proportion may be associated with HL, which was reported to have a correlation with CSF eosinophilia as well ( 12 – 14 ).…”