Bilateral optic neuropathy associated with cryptococcal meningitis in an immunocompetent patient

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Joana Portelinha1, Maria Picoto Passarinho1, Ana Catarina Almeida1

  • 1Department of Ophthalmology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.

BMJ Case Reports
|June 13, 2014
PubMed

Insights

Cryptococcal meningitis can cause severe vision loss in immunocompetent individuals. Prompt diagnosis and multimodal treatment, including antifungal therapy and corticosteroids, are crucial for managing this rare condition.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Ophthalmology

Background:

  • Cryptococcal meningitis is a rare but serious infection, particularly in immunocompetent patients.
  • Its indolent clinical course can delay diagnosis and treatment.

Observation:

  • A 52-year-old immunocompetent woman presented with prolonged symptoms, diagnosed with cryptococcal meningitis.
  • Ophthalmological examination revealed decreased vision, papilledema, and cranial nerve palsies.

Findings:

  • Cranial MRI demonstrated intracranial hypertension, parenchymal lesions, and optic nerve sheath enhancement.
  • Despite CSF pressure management via a ventriculoperitoneal shunt, vision deteriorated.
  • Intravenous methylprednisolone was administered to address optic neuropathy and prevent further visual loss.

Implications:

  • This case highlights the potential for severe neurological and ophthalmological complications of cryptococcal meningitis, even in immunocompetent hosts.
  • Aggressive management, including corticosteroids, may be necessary to preserve vision in cases of cryptococcal meningitis-associated optic neuropathy.

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