Related Experiment Videos
Cryptococcosis in sarcoidosis: cryptOsarc, a comparative study of 18 cases
C Bernard1, D Maucort-Boulch, L Varron
1Department of Internal Medicine, 103 Grande Rue de la Croix-Rousse, 69317 Lyon Cedex 04, France. claire.bernard32@gmail.com
Aim:
To describe the main characteristics and the treatment of cryptococcosis in patients with sarcoidosis.
Design:
Multicenter study including all patients notified at the French National Reference Center for Invasive Mycoses and Antifungals.
Methods:
Retrospective chart review. Each case was compared with two controls without opportunistic infections.
Results:
Eighteen cases of cryptococcosis complicating sarcoidosis were analyzed (13 men and 5 women). With 2749 cases of cryptococcosis registered in France during the inclusion period of this study, sarcoidosis accounted for 0.6% of all the cryptococcosis patients and for 2.9% of the cryptococcosis HIV-seronegative patients. Cryptococcosis and sarcoidosis were diagnosed concomitantly in four cases; while sarcoidosis was previously known in 14/18 patients, including 12 patients (67%) treated with steroids. The median rate of CD4 T cells was 145 per mm(3) (range: 55-1300) and not related to steroid treatment. Thirteen patients had cryptococcal meningitis (72%), three osteoarticular (17%) and four disseminated infections (22%). Sixteen patients (89%) presented a complete response to antifungal therapy. After a mean follow-up of 6 years, no death was attributable to cryptococcosis. Extra-thoracic sarcoidosis and steroids were independent risk factors of cryptococcosis in a logistic regression model adjusted with the sex of the patients.
Conclusions:
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.
