Measurement of cerebrospinal fluid ACE level in aseptic meningitis: diagnostic?. Issue 8 (26th August 2019)

• Record Type: Journal Article
• Authors: Saha, Biplab Kumar; Saha, Aditi; Beegle, Scott
• Is Part Of: BMJ case reports. Volume 12:Issue 8(2019)
• Publication Date: 2019-08-26
• Subjects: cranial nerves -- interstitial lung disease; Medicine -- Case studies -- Periodicals; 610.5
• DOI: 10.1136/bcr-2019-230532
• Languages: English
• ISSNs: 1757-790X

Abstract

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.