Cryptococcosis in sarcoidosis: cryptOsarc, a comparative study of 18 cases. - Université de Rennes Accéder directement au contenu
Article Dans Une Revue QJM: An International Journal of Medicine Année : 2013

Cryptococcosis in sarcoidosis: cryptOsarc, a comparative study of 18 cases.

M. Etienne
  • Fonction : Auteur
I. Gueit
  • Fonction : Auteur
Jean Pouget
  • Fonction : Auteur
  • PersonId : 835082

Résumé

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 mm(3) (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.

Dates et versions

hal-00873410 , version 1 (15-10-2013)

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Citer

C. Bernard, D. Maucort-Boulch, L. Varron, C. Charlier, K. Sitbon, et al.. Cryptococcosis in sarcoidosis: cryptOsarc, a comparative study of 18 cases.. QJM: An International Journal of Medicine, 2013, 106 (6), pp.523-39. ⟨10.1093/qjmed/hct052⟩. ⟨hal-00873410⟩
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