Barreiros Cátia, Meireles-Brandão Lúcia, Silva Duarte, Rodrigues Carmélia, Guerra Diana
Internal Medicine Department, Serviço de Medicina 1, Unidade Local de Saúde do Alto Minho, EPE, Portugal.
Eur J Case Rep Intern Med. 2018 Feb 22;5(2):000778. doi: 10.12890/2017_000778. eCollection 2018.
Sarcoidosis is a risk factor for the development of cryptococcal infection due to dysfunction at T-cell level. Its rarity may, however, delay diagnosis and treatment. We describe the case of a 60-year-old man, diagnosed with sarcoidosis since 1999. He had never received systemic immunomodulatory therapy, such as corticosteroid therapy. In 2012, he was diagnosed with pulmonary cryptococcosis and treated with fluconazole. In April 2013, he presented with symptoms compatible with central nervous system (CNS) infection, namely, meningitis. He was treated with amphotericin B, followed by fluconazole. The clinical outcome was favourable.
Although rare, in patients with sarcoidosis and central nervous system (CNS) symptomatology, it is important to verify the existence of cryptococcal meningitis.Antifungal treatment should be started as early as possible.Before the diagnosis of pulmonary cryptococcosis, dissemination to the CNS should be outruled due to the need for more aggressive treatment.
结节病是由于T细胞水平功能障碍导致隐球菌感染发生的一个危险因素。然而，其罕见性可能会延迟诊断和治疗。我们描述了一名60岁男性的病例，该患者自1999年起被诊断为结节病。他从未接受过全身性免疫调节治疗，如皮质类固醇治疗。2012年，他被诊断为肺隐球菌病并接受氟康唑治疗。2013年4月，他出现了与中枢神经系统（CNS）感染相符的症状，即脑膜炎。他接受了两性霉素B治疗，随后是氟康唑治疗。临床结果良好。
虽然罕见，但对于有结节病和中枢神经系统（CNS）症状的患者，核实是否存在隐球菌性脑膜炎很重要。应尽早开始抗真菌治疗。在诊断肺隐球菌病之前，由于需要更积极的治疗，应排除向中枢神经系统的播散。
