No differences in the proportions of immune cells in CSF of patients with neurosarcoidosis and multiple sclerosis.

BACKGROUND

Multiple sclerosis (MS) and neurosarcoidosis (NS) can present as similar neuro-radiologic syndromes. Neither disease has pathognomonic clinical or laboratory findings and differentiating between them may be challenging. We hypothesized that cerebrospinal fluid (CSF) immune cell profiles, including CD4/CD8 cell ratio and proportion of B cells, might help to distinguish NS from MS.

METHODS

Patients with probable or definite NS who were evaluated at the NYU MS Comprehensive Care Center (New York) and had CSF flow cytometry done as part of diagnostic workup were matched by age, sex, and race/ethnicity to MS patients with available CSF flow cytometry. All patients who received immunomodulatory therapy within 3 months of lumbar puncture were excluded. Flow cytometry was performed using BD FACSCanto™ and FACSCanto™ II Cell Analyzers (BDBiosciences, San Jose, CA) and manually verified by a hematopathologist. Group comparisons were made with an unpaired two-tailed Student's t-test, Chi-square test, or Wilcoxon rank sum test, as appropriate; p < 0.05 was considered significant.

RESULTS

We identified 19 patients with NS and matched them with 19 MS patients by age, sex, and race/ethnicity (mean age NS v. MS: 56.9 ± 10.8 vs. 56.3 ± 9.7 years, p = 0.858; 68 % female in both groups; 74 % vs. 68 % non-white, p = 0.935). NS patients had significantly higher CSF leukocyte counts (16.0 ± 19.9 vs. 2.1 ± 2.6 cells/mm3, p < 0.0001) and protein levels (101.2 ± 88.9 mg/dL vs. 35.7 ± 19.6, p = 0.003), while MS patients had more CSF-restricted oligoclonal bands (7.7 ± 5.3 vs. 1.7 ± 2.4, p < 0.00042). No differences were found in CSF glucose concentrations or IgG indices. Proportions of all immune cells in CSF were similar in NS and MS, including the CD4/CD8 ratio and percentages of B cells.

CONCLUSION

Clinically available CSF flow cytometry immune profiles do not offer added discriminatory value for differentiating NS from MS. More granular immunophenotyping may be needed to improve diagnostic precision.