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Cryptococcal endophthalmitis: case report and review
Abstract:
Cryptococcus neoformans is an opportunistic fungus with a predilection for infecting the meninges. Ocular sequelae of cryptococcal infections of the CNS usually include cranial nerve palsies or papilledema secondary to increased intracranial pressure. Intraocular cryptococcosis occurs less frequently, and over the last 23 years, only 27 cases have been reported, including the case presented here. Intraocular infection was most often manifested by chorioretinal lesions and vitritis. Underlying diseases were detected in only 11 (41%) of the 27 patients. Of note, ocular lesions preceded symptomatic meningitis in six (27%) of 22 patients with CNS involvement. For seven patients, the diagnosis was made by histologic examination of specimens of aqueous or vitreous humor; for another eight patients, the diagnosis was made after enucleation or at autopsy. Ocular involvement frequently led to severe visual loss; return of vision to normal was unusual. Early recognition and treatment may improve outcome for these patients.
Insights
Cryptococcus neoformans can infect the eye, causing serious vision loss. Early diagnosis of ocular cryptococcosis is crucial for better patient outcomes.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Mycology
Background:
- Cryptococcus neoformans is an opportunistic fungus that commonly affects the central nervous system (CNS).
- Ocular complications of CNS cryptococcosis typically involve cranial nerve palsies or papilledema due to increased intracranial pressure.
- Intraocular cryptococcosis is a rare manifestation, with only 27 cases reported over 23 years.
Observation:
- Intraocular infection presented primarily as chorioretinal lesions and vitritis.
- Underlying conditions were identified in 41% of patients.
- Ocular lesions preceded CNS symptoms in 27% of patients with central nervous system involvement.
Findings:
- Diagnosis was confirmed histologically via aqueous or vitreous humor analysis in 7 patients.
- Diagnosis was established post-mortem or after enucleation in 8 patients.
- Severe visual impairment was a common outcome of ocular involvement, with visual recovery being infrequent.
Implications:
- Ocular cryptococcosis can be an early indicator of systemic infection.
- Prompt recognition and therapeutic intervention are essential for potentially improving visual prognosis.
- Further research into early diagnostic markers and treatment strategies for intraocular cryptococcosis is warranted.