This paper describes the case of a patient with progressive respiratory muscle weakness requiring invasive mechanical ventilation. After extensive work-up he was diagnosed with neurosarcoidosis and treated with immunosuppressive drugs. During the ICU stay he developed new pulmonary consolidations and fever. The differential diagnosis of fever and pulmonary infiltrates in a ventilated, immunocompromised patient is extensive. A systematic and probabilistic approach and close cooperation between the intensive care, infectious diseases, radiology, and pulmonology revealed an uncommon aetiology for this second episode of respiratory failure.
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