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

Abstract

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.

Cryptococcal Meningitis Presenting as Endophthalmitis in an Otherwise Asymptomatic Patient

“…5,6 Candida followed by Aspergillus are the most common pathogens. 7 Endogenous cryptococcal endophthalmitis is a rarely encountered entity with a limited number of confirmed cases reported in the literature. 3,4,8 Additionally, its variable clinical manifestations both ophthalmologically and systemically can make the diagnosis difficult.…”

“…[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. 22 We recommended systemic treatment per the Infectious Diseases Society of America's guidelines in conjunction with serial biweekly intravitreal amphotericin or voriconazole until clinical improvement is noted for a minimum of 6 intravitreal injections.…”