Open AccessMeasurement of cerebrospinal fluid ACE level in aseptic meningitis: diagnostic?
Author(s) -
Biplab K. Saha,
Aditi Saha,
Scott Beegle
Publication year - 2019
Publication title -
bmj case reports
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.231
H-Index - 26
ISSN - 1757-790X
DOI - 10.1136/bcr-2019-230532
Subject(s) - medicine , neurosarcoidosis , aseptic meningitis , cerebrospinal fluid , sarcoidosis , dysphagia , pleocytosis , meningitis , differential diagnosis , csf pleocytosis , gastroenterology , pathology , pediatrics , surgery
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.