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CASE REPORT
Measurement of cerebrospinal fluid ACE level in aseptic meningitis: diagnostic?
  1. Biplab Kumar Saha1,
  2. Aditi Saha2 and
  3. Scott Beegle1
  1. 1 Pulmonary and Critical Care Medicine, Albany Medical Center Hospital, Albany, New York, USA
  2. 2 Internal Medicine, Saint Barnabas Medical Center, Livingston, New Jersey, USA
  1. Correspondence to Dr Biplab Kumar Saha, spanophiliac{at}yahoo.com

Abstract

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.

  • cranial nerves
  • interstitial lung disease
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Footnotes

  • Contributors BKS participated in direct patient care. Both BKS and AS participated in the preparation of the manuscript. SB supervised the preparation of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Obtained.

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