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Rostomian, Khodam; Kolahdouz-Isfahani, Amir H; Thach, Allen B.; Rao, Narsing A.

doi:10.1023/a:1005810624388

Cited by 7 publications

(4 citation statements)

References 17 publications

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“…However, several cases in the literature describe asymptomatic choroidal lesions that preceded CNS involvement. 3,6,7 Ocular examination with indirect ophthalmoscopy allows identification of choroidal lesions similar to those seen in our patient and may serve as an important diagnostic modality; it raises clinical suspicion for early cryptococcal meningitis, providing an opportunity for timely treatment and improvement in patient survival.…”

Section: Resultsmentioning

confidence: 61%

Bilateral Placoid Choroiditis in an HIV-Positive Patient With Cryptococcus neoformans Meningitis and Disseminated Cryptococcal Disease

Larochelle

Aung

et al. 2020

Journal of VitreoRetinal Diseases

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Purpose: We report a presumptive case of bilateral placoid choroiditis secondary to disseminated Cryptococcus neoformans infection and review the literature on choroidal involvement of C neoformans. Methods: A case report is presented. Results: A 35-year-old HIV-positive man presented with disseminated cryptococcal infection. Cryptococcal meningitis was confirmed by lumbar puncture, and skin involvement was confirmed by microscopy of scrapings from a papular, umbilicated, ulcerated lesion. Ophthalmologic examination revealed intact visual acuity, clear vitreous, and multiple yellowish, placoid-appearing choroidal lesions in the posterior pole bilaterally. Conclusions: Multifocal choroiditis caused by C neoformans is an uncommon manifestation of disseminated infection, and placoid yellowish choroidal lesions are an unusual variant. These findings must be differentiated from choroidal tuberculosis and other infections. Multifocal choroiditis typically occurs in AIDS patients and may precede the presentation of meningitis. In such patients, choroidal lesions warrant investigation for systemic, life-threatening opportunistic infections.

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Section: Resultsmentioning

confidence: 61%

Bilateral Placoid Choroiditis in an HIV-Positive Patient With Cryptococcus neoformans Meningitis and Disseminated Cryptococcal Disease

Larochelle

Aung

et al. 2020

Journal of VitreoRetinal Diseases

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“…18 However, the relapse or therapeutic failure rate may be as high as 33% on this regimen in patients with cryptococcal endophthalmitis. [19][20][21] Several reports have described patients with cryptococcal meningitis or endophthalmitis as responsive to voriconazole after failing amphotericin and flucytosine treatment, which has been proposed to be related to superior intravitreal penetration. 7 Voriconazole administered orally reaches intravitreal concentrations of 1.0 to 1.5 mg/mL, which are well above the minimum inhibitory concentration and have no significant toxicity in concentrations up to 250 mg/mL.…”

Section: Discussionmentioning

confidence: 99%

Cryptococcal Meningitis Presenting as Endophthalmitis in an Otherwise Asymptomatic Patient

Peck

Ammar

Dunn

2020

Journal of VitreoRetinal Diseases

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Purpose: Cryptococcus neoformans is a budding yeast that has a tropism for the central nervous system where it may cause meningitis, which has a high mortality rate. Endophthalmitis is rare and typically occurs in the setting of meningitis and disseminated disease. This report describes an atypical presentation of cryptococcal endophthalmitis and outlines the appropriate workup and management for this disease. Methods: A case report is presented. Results: A 66-year-old man on chemotherapy who presented with blurry vision without any extraocular symptoms was diagnosed with cryptococcal endophthalmitis and found to have underlying bloodstream and central nervous system infection on subsequent workup. He was treated with intravenous and intravitreal antifungals and remained systemically well, although a large subretinal mass lesion remained stable at 2-month follow-up. Conclusions: Cryptococcal endophthalmitis may be the initial presentation of disseminated cryptococcal disease. If vitreous cultures grow Cryptococcus, clinicians should presume that meningitis is present, regardless of symptoms, until proven otherwise.

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“…[ 10 ] Cryptococcal endophthalmitis is an infrequent entity, and treatment usually consists of amphotericin B or flucytosine, with therapeutic failure or relapses being reported in approximately 33% of cases. [ 8 9 11 ] There are some case reports of cryptococcal meningitis and endophthalmitis being successfully treated with voriconazole, especially to patients who had a treatment failure with amphotericin B alone or accompanied by fluconazole. [ 12 13 ] Sheu et al .…”

Section: Discussionmentioning

confidence: 99%

Endogenous Cryptococcus neoformans endophthalmitis with subretinal abscess in a HIV-infected man

Joseph

Sharma

Narayanan

2018

Indian J Ophthalmol

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To report a rare case of Cryptococcus neoformans endogenous endophthalmitis with subretinal abscess in a 36-year-old HIV-positive man, referred with progressive blurred vision in his right eye for the last 6 months. Vitreous biopsy followed by intravitreal ganciclovir did not result in significant improvement. Microbiology revealed the presence of C. neoformans, and intravitreal amphotericin B was then administered. The patient was treated aggressively with systemic and intravitreal antifungals but had a poor visual and anatomical outcome. A high degree of clinical suspicion combined with microbiological evaluation helped to arrive at an appropriate diagnosis.

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Abstract: Primary choroidal lesions in patients with AIDS may herald severe systemic disseminated disease. Funduscopic examination, however, may detect disseminated cryptococcal disease before other overt clinical manifestations, thereby allowing prompt institution of effective therapy.

Cited by 7 publications

References 17 publications

Bilateral Placoid Choroiditis in an HIV-Positive Patient With Cryptococcus neoformans Meningitis and Disseminated Cryptococcal Disease

Bilateral Placoid Choroiditis in an HIV-Positive Patient With Cryptococcus neoformans Meningitis and Disseminated Cryptococcal Disease

Cryptococcal Meningitis Presenting as Endophthalmitis in an Otherwise Asymptomatic Patient

Endogenous Cryptococcus neoformans endophthalmitis with subretinal abscess in a HIV-infected man

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