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Curtains

Paul H Phillips1, Edgardo Angtuaco, Rudy L VanHemert

  • 1University of Arkansas Medical Center, and Arkansas Children’s Hospital, Little Rock, Arkansas 72202, USA. PhillipsPaulH@uams.edu

Survey of Ophthalmology
|August 23, 2011
PubMed

Insights

Cryptococcal meningitis can rarely cause bilateral cranial nerve III dysfunction, leading to ptosis and diplopia. Prompt treatment with antifungal medications resolved neurological symptoms and imaging lesions.

Area of Science:

  • Neuroscience
  • Infectious Diseases
  • Ophthalmology

Background:

  • Cryptococcal meningitis is a serious fungal infection primarily affecting immunocompromised individuals.
  • Cranial nerve palsies are known complications, but isolated bilateral cranial nerve III dysfunction is rare.

Observation:

  • A 55-year-old immunocompetent male presented with headache, nausea, and progressive bilateral ptosis and diplopia.
  • Ophthalmological examination revealed bilateral asymmetric ptosis and restricted eye movements (adduction and elevation).

Findings:

  • Cranial MRI demonstrated enhancing intra-axial and extra-axial lesions in the midbrain.
  • Cerebrospinal fluid analysis confirmed Cryptococcus neoformans infection via positive antigen and fungal cultures.
  • The patient received liposomal amphotericin B and flucytosine for treatment.

Implications:

  • This case highlights that cryptococcal meningitis, even in immunocompetent hosts, can manifest with isolated bilateral cranial nerve III palsies.
  • Early diagnosis and appropriate antifungal therapy are crucial for favorable neurological outcomes.
  • Clinicians should consider cryptococcal meningitis in the differential diagnosis of unexplained bilateral cranial nerve III dysfunction.

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