TY - JOUR T1 - Disseminated Cryptococcal Infection and Anti-Tumor Necrosis Factor-α Treatment for Refractory Sarcoidosis: An Expected Association? JF - The Journal of Rheumatology JO - J Rheumatol SP - 462 LP - 462 DO - 10.3899/jrheum.080426 VL - 36 IS - 2 AU - LAURENT ARNAUD AU - DAMIEN SENE AU - NATHALIE COSTEDOAT-CHALUMEAU AU - PATRICE CACOUB AU - CATHERINE CHAPELON-ABRIC AU - JEAN-CHARLES PIETTE Y1 - 2009/02/01 UR - http://www.jrheum.org/content/36/2/462.abstract N2 - The use of anti-tumor necrosis factor-α(anti-TNF-α) agents is validated in refractory rheumatoid arthritis, psoriatic arthritis, ankylosing spondylitis, Crohn’s disease, and ulcerative colitis. Although very effective in breaking down granulomatous inflammation typically involved in sarcoidosis, anti-TNF-α agents significantly reduce the host granulomatous defence mechanisms that normally contain pathogens such as mycobacteria and fungi. We describe a case of disseminated cryptococcosis in a patient with refractory systemic sarcoidosis, in whom complete resolution followed discontinuation of anti-TNF-α drug and antifungal therapy. A 42-year-old man was referred to our internal medicine department with a 2-year history of unexplained left-ear deafness and lymphocytic meningitis. Clinical examination was normal except for left-ear deafness. Gadolinium-enhanced magnetic resonance imaging (MRI) showed multiple solid enhancing lesions involving the left internal acoustic canal and the left frontal lobe. Cerebrospinal fluid (CSF) analysis revealed lymphocytosis (85/mm3), elevated CSF protein (1.24 g/l), and low glucose CSF concentrations (1.4 mmol/l). Viral, bacterial, and fungal cultures were negative. Thoracic computed tomography … Address reprint requests to Dr Sène; E-mail: damien.sene{at}psl.aphp.fr ER -