Abstract
Anti-N-methyl-D-aspartate receptor (NMDAR) encephalitis is an autoimmune disorder, seen most often in young adults and children, triggered by tumors or infections. We report a case of cryptococcal meningitis in a patient with sarcoidosis, presenting prominent neuropsychiatric symptoms, electroencephalographic features of autoimmune encephalitis and positive anti-NMDAR antibodies in the cerebrospinal fluid, raising the hypothesis of an infectious immune-mediated mechanism triggering the production of anti-NMDAR antibodies. Since anti-NMDAR encephalitis is potentially fatal and has significant morbidity, further descriptions of its etiological associations are essential to early identification and prompt treatment.
Highlights
Sarcoidosis is a multisystem granulomatous disease of unknown etiology
We report a case of concomitant cryptococcal meningitis and antiNMDAR encephalitis in a sarcoidosis adult patient
A preliminary diagnosis of neurosarcoidosis determined an increase in steroid dosing, which led to clinical deterioration
Summary
Sarcoidosis is a multisystem granulomatous disease of unknown etiology. Lymphopenia is common (Crouser et al, 2010; Jamilloux et al, 2015; Morell et al, 2002; Yanardag et al, 2002) and T-cell mediated immunity has been shown to be impaired (Adams and Gibson, 2016; Bernard et al, 2013; Dhote et al, 2009; Jamilloux et al, 2015; Leonhard et al, 2016; Miyara, 2006; Ross and Katz, 2002). There is significant evidence that herpes simplex can trigger anti-NMDAR encephalitis (Armangue et al, 2013, 2014; Prüss et al, 2012; Venkatesan and Benavides, 2015); there are reports of possible links to Varicella-Zoster virus (Dalmau et al, 2011; Schabitz et al, 2014), influenza virus, Japanese Encephalitis virus (Ma et al, 2017) and Human Immunodeficiency Virus (HIV) (Arboleya et al, 2016; Patarata et al, 2016), but, to our knowledge, it has not yet been reported any association to fungal infection. Anti-NMDAR encephalitis can lead to death if untreated and is associated with significant morbidity (Lynch et al, 2018; Venkatesan and Benavides, 2015).
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