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Cryptococcal choroiditis
M D Carney1, J L Combs, W Waschler
1Department of Ophthalmology, Medical College of Virginia, Virginia Commonwealth University, Richmond.
Retina (Philadelphia, Pa.)
|January 1, 1990
Summary
This study details two cases of cryptococcal meningitis in AIDS patients, highlighting ocular complications like choroiditis and optic disc edema. Prompt treatment with amphotericin B and 5-flucytosine resolved ocular infiltrates.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Immunology
Background:
- Acquired Immune Deficiency Syndrome (AIDS) predisposes individuals to opportunistic infections.
- Cryptococcal meningitis is a serious central nervous system infection caused by Cryptococcus neoformans.
- Ocular manifestations of cryptococcosis can significantly impact patient vision.
Observation:
- Two patients with AIDS presented with headaches, fevers, and decreased vision.
- Lumbar puncture confirmed cryptococcal meningitis with elevated cryptococcal antigens.
- Ophthalmoscopic examination revealed bilateral optic disc edema and cryptococcal choroiditis with characteristic yellow-white infiltrates.
Findings:
- Systemic antifungal therapy, including amphotericin B and 5-flucytosine, was initiated.
- Treatment led to the successful resolution of the observed choroidal infiltrates.
- Despite treatment, late visual acuity loss occurred, attributed to secondary optic atrophy.
Implications:
- Early diagnosis and aggressive antifungal treatment are crucial for managing ocular cryptococcosis in AIDS patients.
- Ocular involvement in cryptococcal meningitis requires prompt recognition and management to prevent vision loss.
- Optic nerve damage (optic atrophy) remains a significant risk factor for long-term visual impairment even after successful infection control.