Against a background of hypertension and migraine, a 54-year-old man was admitted to our hospital after 2 months with palpitations and activity-related presyncope, as well as influenza-like symptoms. Chest X-ray was normal. Electrocardiography showed type-II atrioventricular-block. A tentative diagnosis of myocarditis was made. Figure gives a timeline presentation of the successive diagnoses and the main clinical investigations. Three weeks later, magnetic resonance imaging (MRI) showed oedema and multiple nodular structures in the heart. Positron-emission tomography (PET) revealed uptake by mediastinal lymph glands, some minor activity in the heart, and focal marked uptake in the right thyroid lobe, suspicious of malignancy. Chest computed tomography (CT) reported minor (10 mm) hilar lymph glands and multiple 2–5 mm nodular lesions in the lungs. Endomyocardial biopsies showed fibrosis and granulomas, in the absence of infectious agents, prompting a diagnosis of cardiac sarcoidosis. An automated defibrillator was implanted and corticosteroid therapy (prednisone) initiated. Three months later, a fine needle aspirate of the thyroid was reported as suspicious for papillary thyroid carcinoma (PTC). A thyroid lobectomy was performed 27 days later, and pathology showed a BRAF-positive encapsulated PTC measuring 28 mm with diffuse necrosis. Four days postoperatively the patient developed signs and symptoms of meningoencephalitis. There were 39 leukocytes per μl cerebrospinal fluid (CSF) (with both polynuclear and mononuclear cells). Blood samples revealed the same findings as during the preceding 3 months; granulocytosis and minor lymphopenia. Antiviral therapy was started, but CSF and blood cultures 2 days later yielded growth of C. neoformans, identified at species level using matrix-assisted laser desorption/ionization-time-of-flight mass spectrometry (MALDI-TOF MS). Fluconazole (800 mg) was given intravenously before the patient was transferred to a central hospital and the antifungal regimen was then changed to amphotericin B (a daily 200 mg infusion) plus flucytosine (1500 mg infusion twice daily); one month later parenteral treatment was terminated and flucytosine (1500 mg × 2) plus fluconazole (400–800 mg daily) were given during the next month, to be followed by fluconazole (400 mg) until 1 year. Cerebrospinal fluid was sampled weekly, showing sparse growth of C. neoformans after 1 week while later samples were without growth but with decreasing quantity documented by a C. neoformans antigen test until 2 months later. Neurological status including cognitive function was noted to be fully normalized at 1 month after onset of the cryptococcal infection. There were no signs of cryptococcus infection at follow-up 15 months after diagnosis, and antifungal treatment was terminated. A retrospective fungal staining of the thyroid specimen revealed widespread cryptococcal elements in the PTC. In addition, cryptococcal elements were observed intravascularly, in the few non-necrotizing granulomas located in the thyroid parenchyma as well as in an adjacent lymph gland. The types and distribution of cells within the thyroid granulomas were typical for those commonly seen upon histopathologic examination of granulomatous inflammation, with centrally located giant cells and epitheloid histiocytes dominating, and with lymphocytes only at the outer rim []. Notably, there was no evidence of cryptococci in the heart sarcoid sections or in non-cancerous thyroid parenchyma adjacent to areas with tumour transformation. At the 2-year follow-up there was no evidence of thyroid cancer relapse, but the cardiac sarcoidosis was still active.