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Neurosarcoidosis — SCE Infectious Diseases MCQ

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ModerateCNS InfectionNeurosarcoidosisSCE Infectious Diseases

A 62-year-old man develops chronic meningitis with lymphocytic CSF. He has sarcoidosis affecting the lungs and skin. CSF shows raised protein, low glucose, and lymphocytic pleocytosis. CSF ACE is elevated. All microbiological investigations are negative. What is the most likely diagnosis?

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Correct answer: C — Neurosarcoidosis (chronic lymphocytic meningitis is a common CNS manifestation of sarcoidosis)

Chronic lymphocytic meningitis with low glucose and raised protein in a patient with known systemic sarcoidosis is most consistent with neurosarcoidosis. CSF ACE elevation supports the diagnosis (though sensitivity is limited — ~50%). Neurosarcoidosis can affect meninges, cranial nerves (particularly facial nerve — bilateral palsy), hypothalamus, and spinal cord. Diagnosis is often one of exclusion — TB, Cryptococcus, and malignancy must be ruled out. Treatment is high-dose corticosteroids; Methotrexate or Infliximab for refractory disease.

Reference: BTS 2024 – Sarcoidosis; NICE 2024 – Neurosarcoidosis; ATS 2020