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Reversible visual disturbance due to cryptococcal uveitis in a non-HIV individual
Shigeki Nakamura1, Koichi Izumikawa, Masafumi Seki
1Second Department of Internal Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Medical Mycology
|April 17, 2008
Summary
Disseminated cryptococcosis, a rare fungal infection, can manifest subtly. Early diagnosis and treatment with fluconazole (FLCZ) are crucial for recovery, even in complex cases involving hydrocephalus and uveitis.
Area of Science:
- Infectious Diseases
- Ophthalmology
- Neurosurgery
Background:
- Hydrocephalus management often involves cerebrospinal fluid (CSF) shunting procedures.
- Cryptococcosis is a serious fungal infection, typically affecting immunocompromised individuals.
- Disseminated cryptococcosis can present with varied and sometimes subtle symptoms.
Observation:
- A 52-year-old man developed uveitis and other symptoms after ventricular-atrial (V-A) shunt placement for hydrocephalus.
- Diagnostic tests revealed positive Cryptococcus antigen in serum, CSF, aqueous humor, and prostate fluid.
- Cryptococcus neoformans var. grubii was isolated from multiple bodily fluids and blood.
Findings:
- The patient was diagnosed with disseminated cryptococcosis, a rare complication post-V-A shunt.
- Treatment with fluconazole (FLCZ) led to successful recovery of visual function.
- This case highlights the importance of considering fungal infections in shunt recipients.
Implications:
- Disseminated cryptococcosis should be suspected in patients with hydrocephalus and V-A shunts presenting with atypical symptoms.
- Prompt diagnosis and aggressive antifungal therapy are vital for favorable outcomes.
- Ophthalmological and neurological monitoring are essential in managing cryptococcal infections.
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