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Fever, Headache, and Visual Blurring in a 17-Year-Old Woman

  • William Lynn,
  • Sue Lightman
  • Published: October 19, 2004
  • DOI: 10.1371/journal.pmed.0010007

Reader Comments (4)

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Sarcoidosis and CSF glucose

Posted by plosmedicine on 30 Mar 2009 at 23:37 GMT

Author: Eeva Salo
Position: Infectious disease pediatrician, consultant
Institution: Hospital for Children and Adolescents, University of Helsinki, Finland
Submitted Date: October 25, 2004
Published Date: October 25, 2004
This comment was originally posted as a “Reader Response” on the publication date indicated above. All Reader Responses are now available as comments.

Dear Editor,

Thank you for a new and very interesting publication. I found the case in the Learning Forum "Fever, headache and visual blurring in a 17-y old woman " by William Lynn and Sue Lightman interesting, exciting and informative. It acquainted me with a disease I was not familiar with before.

The quiz was good too, it is a good opportunity to test your knowledge. However, I was puzzled by question nr. 6: Which of the following is most likely to cause a low CSF glucose? Neurosarcoidosis, enteroviral meningitis or drug-induced meningitis?

I have been used to think that the reason for a low CSF glucose is that the causative agent uses the glucose for its metabolism. This did not seem a possible solution in the Question.

The correct answer given is neurosarcoidosis. I am not an expert on sarcoidosis, but I read the article by Zajicek et al. (1) given as reference. Sixty-eight patients were identified as having definite or probable neurosarcoidosis. Twelve patients had histological confirmation from CNS tissue in the absence of any other identifiable cause, and thus fulfilled the criteria for definite neurosarcoidosis. CSF glucose results were available for 46 patients, of whom 44 had normal results. One patient had a CSF glucose 31% of blood glucose and one a remarkably low 0.29 mmol/l in CSF against serum concentration of 5 mmol/l. We do not whether these patients were classified as probable or definite cases of neurosarcoidosis.

I suggest that the right answer to question nr. 6 is none of the options given.

Yours sincerely

Eeva Salo
(1) Zajicek JP, Scolding NJ, Foster O Central nervous system sarcoidosis - diagnosis and management. QJM 1999;92:103-17.

Competing interests declared: I declare I have no competing interests.