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Neurosarcoidosis Presentation — SCE Infectious Diseases MCQ

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HardCNS InfectionNeurosarcoidosis PresentationSCE Infectious Diseases

A patient has chronic lymphocytic meningitis, bilateral facial palsies, parotid enlargement and hilar lymphadenopathy. Initial bacterial, mycobacterial and fungal tests are negative. What is the best next diagnostic framing?

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Correct answer: A — Consider neurosarcoidosis, but obtain tissue where feasible and continue excluding infection and malignancy before immunosuppression with review after review with follow-up

The best answer is “Consider neurosarcoidosis, but obtain tissue where feasible and continue excluding infection and malignancy before immunosuppression with review after review with follow-up”. The multisystem pattern supports sarcoidosis, but neither serum ACE nor imaging is specific enough to bypass tissue diagnosis and infectious exclusion. “Diagnose neurosarcoidosis from serum ACE alone” does not match the decisive clinical feature or cited guidance. “Treat cryptococcosis despite repeatedly negative targeted tests and no antigen” does not match the decisive clinical feature or cited guidance. “Diagnose tuberculosis solely from low CSF glucose” does not match the decisive clinical feature or cited guidance. “Diagnose carcinomatous meningitis without cytology or tissue” does not match the decisive clinical feature or cited guidance.

Reference: BTS clinical statement on pulmonary sarcoidosis: https://thorax.bmj.com/content/76/1/4