Cryptococcal Meningitis in a HIV-Negative Patient

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, Cryptococcus neoformans meningitis. He was treated with amphotericin B, followed by fluconazole. The clinical outcome was favourable. LEARNING POINTS: 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.