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- Title
Cryptococcosis in sarcoidosis: cryptOsarc, a comparative study of 18 cases.
- Authors
BERNARD, C.; MAUCORT-BOULCH, D.; VARRON, L.; CHARLIER, C.; SITBON, K.; FREYMOND, N.; BOUHOUR, D.; HOT, A.; MASQUELET, A. C.; VALEYRE, D.; COSTEDOAT-CHALUMEAU, N.; ETIENNE, M.; GUEIT, I.; JOUNEAU, S.; DELAVAL, P.; MOUTHON, L.; POUGET, J.; SERRATRICE, J.; BRION, J.-P.; VAYLET, F.
- Abstract
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 mm3 (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.
- Publication
QJM: An International Journal of Medicine, 2013, Vol 106, Issue 6, p523
- ISSN
1460-2725
- Publication type
Article
- DOI
10.1093/qjmed/hct052