Measurement of cerebrospinal fluid ACE level in aseptic meningitis: diagnostic?

Neurosarcoidosis (NS) is a rare disease, affecting only 3%–10% of patients with sarcoidosis. The clinical presentation can be protean and often represents a diagnostic challenge. Cerebrospinal fluid (CSF) ACE level has poor sensitivity, but high specificity for establishing a diagnosis of NS. We pre...

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Bibliographic Details
Published in:BMJ case reports 2019-08, Vol.12 (8), p.e230532
Main Authors: Saha, Biplab Kumar, Saha, Aditi, Beegle, Scott
Format: Article
Language:English
Subjects:
Biomarkers - cerebrospinal fluid
Biopsy
Blood
Brain - diagnostic imaging
Case reports
Central Nervous System Diseases - cerebrospinal fluid
Central Nervous System Diseases - complications
Central Nervous System Diseases - diagnosis
Central Nervous System Diseases - drug therapy
Cerebrospinal fluid
Cerebrospinal Fluid - cytology
Cerebrospinal Fluid - metabolism
Consortia
Deglutition Disorders - diagnosis
Deglutition Disorders - etiology
Diagnosis, Differential
Dysphagia
Dysphonia - diagnosis
Dysphonia - etiology
Enzymes
Epidemiology
Family medical history
Female
Glucocorticoids - administration & dosage
Guillain-Barre syndrome
Headaches
Humans
Leukocytosis - cerebrospinal fluid
Leukocytosis - diagnosis
Leukocytosis - etiology
Lymphocytes - pathology
Medical diagnosis
Medical imaging
Meningitis
Middle Aged
Nervous system
Ostomy
Patients
Peptidyl-Dipeptidase A - cerebrospinal fluid
Rare Disease
Sarcoidosis
Sarcoidosis - cerebrospinal fluid
Sarcoidosis - complications
Sarcoidosis - diagnosis
Sarcoidosis - drug therapy
Treatment Outcome
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Description
Summary:Neurosarcoidosis (NS) is a rare disease, affecting only 3%–10% of patients with sarcoidosis. The clinical presentation can be protean and often represents a diagnostic challenge. Cerebrospinal fluid (CSF) ACE level has poor sensitivity, but high specificity for establishing a diagnosis of NS. We present a case of NS in a middle-aged African American woman who presented with dysphagia and dysphonia. An extensive radiological workup was negative for structural brain disease. CSF studies demonstrated lymphocyte predominant pleocytosis with an elevated ACE level. A diagnosis of possible neurosarcoidosis was made. She responded to systemic steroid therapy with complete resolution of her symptoms over the next five months. In the appropriate clinical setting, an elevated CSF ACE level could be of paramount importance for making a diagnosis of NS.
ISSN:1757-790X
1757-790X
DOI:10.1136/bcr-2019-230532