Cerebrospinal fluid CD4+/CD8+ ratio in diagnosing neurosarcoidosis

Abstract

Objective: Neurosarcoidosis affects 5%-10% of patients with sarcoidosis. CD4+/CD8+ ratio in bronchoalveolar lavage is included in diagnostic routine for pulmonary sarcoidosis. Previously, it has been suggested that a cerebrospinal fluid CD4+/CD8+ ratio ≥5 can be an aid in diagnosing neurosarcoidosis. Materials and Methods: This study included 66 cases where neurosarcoidosis was a differential diagnosis and hence subjected to the analysis of CSF CD4+/CD8+ ratio by flow cytometry. Results: Eleven cases of neurosarcoidosis, had a significantly higher median CSF CD4+/CD8+ ratio than the other group, P =.024. The median CSF CD4+/CD8+ ratio was 4.2, hence not reaching the suggested level of ≥5 for diagnosing neurosarcoidosis. When combined, the elevated CSF CD4+/CD8+ ratio ≥5 and an elevated CSF lymphocyte count ('3 lymphocytes/uL) gave a positive predictive value of 57% and a high negative predictive value of 88%, with a specificity of 95% for neurosarcoidosis. Conclusion: The study confirms that increased CSF CD4+/CD8+ ratio is associated with neurosarcoidosis but cannot alone distinguish the conditions from other neurological diagnoses. However, a ratio below '5 combined with an absence of pleocytosis in CSF yields a negative predictive value (NPV) of 88% suggesting a role for the analysis in differential diagnosing neuroinflammatory conditions.