Cryptococcal Meningitis With Acute Psychotic Confusion in a Sarcoid Patient

Sir: Cryptococcosis is a systemic fungal disease, usually caused by Cryptococcus neoformans, often transmitted by inhalation of dust or contaminated soil. The diagnosis of cryptococcal meningitis is difficult because of its various presentations. Non–HIV-contaminated patients may present brief mental confusion, coma, subacute or chronic meningitis, encephalitis, focal brain or spinal cord lesions, or mental changes.1–3 Sarcoidosis is an idiopathic granulomatous illness. While any organ may be involved, 90% of patients develop pulmonary disease. Sarcoidosis is associated with deficient cell-mediated immunity, because of sequestration of CD4 cells in sarcoid granulomas, anergy, and reversal of the CD4/CD8 ratio.4 Concurrent cryptococcal disease in sarcoid patients is not rare, even in the absence of immunosuppressive therapy, and it may be misdiagnosed as neurosarcoidosis.

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