AIDS-related Cryptococcus neoformans choroiditis

Canfield, Gregory S; Reingold, Sarah; Ho, Alexandra; Thor, Ann D.; Pecen, Paula E.; DeSanto, Kristen; Chastain, Daniel B; Franco‐Paredes, Carlos; Castillo‐Mancilla, José; Henao-Martínez, Andrés F

doi:10.1016/j.idcr.2020.e00931

Cited by 4 publications

(3 citation statements)

References 42 publications

(46 reference statements)

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“…Conversely, involvement of the choroidal regions is exceptionally uncommon, representing a mere 3% of occurrences as ascertained through postmortem investigations [ 6 ]. Furthermore, it has been reported that chorioretinal involvement is linked to hematogenous dissemination of cryptococcus through the choroidal vasculature, rather than contiguous infection through the meninges, unlike most ocular presentations [ 7 , 8 ].…”

Section: Discussionmentioning

confidence: 99%

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Bilateral Cryptococcal Choroiditis in a Human Immunodeficiency Virus-Infected Patient: A Case Report

Sanfilippo,

Docquier,

Schrooyen

et al. 2024

Case Rep Ophthalmol

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Introduction: In this case report, we present a rare case of bilateral cryptococcal choroiditis following a diagnosis of meningitis in a 38-year-old woman with HIV. Case Presentation: A Colombian woman, newly diagnosed with HIV, presented with respiratory distress followed by meningeal syndrome. Further evaluation revealed cryptococcal meningitis caused by Cryptococcus neoformans, confirmed through cerebrospinal fluid analysis and brain magnetic resonance imaging. The patient reported mild blurred vision, prompting an ophthalmic examination that included indocyanine green angiography. The findings revealed signs of HIV retinopathy and multifocal choroidal lesions in both eyes, suggestive of choroidal cryptococcosis. Treatment involved intravenous administration of amphotericin B and flucytosine, followed by oral fluconazole. Subsequently, the choroidal lesions gradually regressed, and regular monitoring demonstrated no signs of recurrence. Conclusion: Cryptococcal choroiditis, though exceptionally rare, can occur in HIV-positive patients with disseminated cryptococcosis. Ophthalmologists should maintain a high index of suspicion for opportunistic infections, even in the absence of pronounced ocular symptoms, particularly in immunocompromised individuals. Early diagnosis and appropriate treatment are crucial for achieving favorable outcomes in such cases.

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Section: Discussionmentioning

confidence: 99%

“…Systemic treatment can be complemented by intravitreal injections of amphotericin B, but there are no clear guidelines, and therefore, it is conducted on an individualized basis. Vigilant monitoring of antiretroviral therapy is crucial to prevent an immune recovery reaction [ 8 ].…”

Section: Discussionmentioning

confidence: 99%

Bilateral Cryptococcal Choroiditis in a Human Immunodeficiency Virus-Infected Patient: A Case Report

Sanfilippo,

Docquier,

Schrooyen

et al. 2024

Case Rep Ophthalmol

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“…Most cases were reported in patients with concomitant immunosuppression. Previous cases were reported in patients with advanced AIDS [ 8 – 10 ] or with T cell leukemia [ 11 ]. As described in the latter cases [ 8 , 9 ], EDI-OCT and ICG have proven most useful in directing the diagnostic algorithm in panuveitis in immunosuppressed patients by defining the localization of lesions and assessing response to treatment.…”

Section: Discussionmentioning

confidence: 99%

Multimodal Imaging in AIDS-Related Ocular Cryptococcosis

Herrera

Dauby

Maillart

et al. 2021

Case Reports in Ophthalmological Medicine

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Purpose. To report multimodal imaging findings in two cases of AIDS-related cryptococcal chorioretinitis associated with uveitis and vasculitis. Methods. Findings on clinical examination, color fundus photography, fluorescein and indocyanine green angiographies, and optical coherence tomography. Patients. Both patients were diagnosed with Cryptococcus neoformans meningitis in the setting of untreated HIV infection with CD4+ T cell count < 100 / m m 3 . Ocular manifestations occurred during the course of the antifungal therapy for meningitis. Results. In both cases, fundus showed vitritis. Fluorescein angiography allowed the characterization of vasculitis lesions, and indocyanine green angiography indicated choroidal involvement. In combination with optical coherence tomography, ICG and FA allowed the assessment of treatment response. Conclusion. These two cases reveal the potential of C. neoformans to infect almost all ocular structures and the critical role of multimodal imaging in baseline evaluation and in the follow-up of patients.

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