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Amphotericin B induced ocular toxicity in cryptococcal meningitis.
1Department of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin.
The British Journal of Ophthalmology
|May 1, 1989
Summary
Acute visual loss occurred after a test dose of amphotericin B in a patient with cryptococcal meningitis. Amphotericin B may worsen optic nerve disease, suggesting it should be avoided in such cases.
Area of Science:
- Neurology
- Ophthalmology
- Infectious Diseases
Background:
- Cryptococcal meningitis is a serious fungal infection often affecting immunocompromised individuals.
- Systemic lupus erythematosus (SLE) is an autoimmune disease that can increase susceptibility to infections.
- Intravenous amphotericin B is a common antifungal agent used to treat invasive fungal infections.
Observation:
- A patient with SLE and cryptococcal meningitis experienced sudden, acute visual loss.
- Visual acuity was normal before the administration of a low-dose (1 mg) intravenous amphotericin B test dose.
- The patient's meningitis later improved with miconazole and flucytosine therapy.
Findings:
- The case suggests a potential link between amphotericin B administration and acute visual loss in patients with cryptococcal meningitis.
- Optic nerve involvement may be a contraindication for amphotericin B treatment in this context.
- Alternative antifungal treatments were effective in managing the meningitis.
Implications:
- Clinicians should consider the risk of visual disturbances when using amphotericin B for cryptococcal meningitis.
- Suspected optic nerve disease in patients with cryptococcal meningitis warrants careful consideration of alternative antifungal strategies.
- This case highlights the importance of monitoring visual function during antifungal therapy for meningitis.