Cryptococcosis in sarcoidosis: cryptOsarc, a comparative study of 18 cases

Abstract

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.

A Cross-Sectional Study of Cryptococcal Antigenemia in Anti-Retroviral Naive Hiv Infected Patients

“…8 Other risk groups for cryptococcosis are transplant recipients on immunosuppressants and those with haematopoietic or other malignancies, advanced renal or liver disease, solid organ malignancy, sarcoidosis, rheumatologic disease and diabetes mellitus. [9][10][11] Detection of cryptococcal antigen in serum can be used as a presumptive diagnosis of cryptococcal meningitis. 12 An overall prevalence of 15% of cryptococcal antigenemia was observed in our study.…”

Cryptococcal eosinophilic meningitis in a patient with sarcoidosis

“…Although uncommon, sarcoidosis has been established as an independent and important risk factor for development of CNS cryptococcosis. This association appears to occur regardless of the use of steroids or immunosuppressive drugs, although their use may play a role in facilitating the dissemination of the infection 15. The diagnosis of CNS cryptococcosis can be made by detecting the encapsulated yeast form of the fungus in the CSF using India ink stain.…”

Cryptococcal meningitis complicating sarcoidosis

“…3 and Supplementary Table 1). [4,7–14,16–20,23–34] Cases were excluded if they had a positive HIV status or immunocompromised status of other cause. Patients treated for sarcoidosis with immunomodulating therapy were included.…”

“…[3] A minority of cryptococcal meningitis cases occur in HIV-negative patients and half of these patients have a co-existing immunocompromised state, for instance, due to glucocorticoid treatment, hematologic malignancy, or organ transplantation. [4–6] Cryptococcal meningitis is an uncommon complication of sarcoidosis. [4,6–20] In patients with sarcoidosis T-cell-mediated immunity has been shown to be impaired, which might be explained by a combination of sequestering of CD4-T cells in granulomas and suppression of T-cell proliferation by regulatory CD4 T-cells causing anergy.…”

“…[4–6] Cryptococcal meningitis is an uncommon complication of sarcoidosis. [4,6–20] In patients with sarcoidosis T-cell-mediated immunity has been shown to be impaired, which might be explained by a combination of sequestering of CD4-T cells in granulomas and suppression of T-cell proliferation by regulatory CD4 T-cells causing anergy. [21–23] We present 2 patients with cryptococcal meningitis complicating sarcoidosis and performed a meta-analysis of our cases and those identified in the literature.…”