Related Experiment Videos
Amphotericin B induced ocular toxicity in cryptococcal meningitis
1Department of Medicine, Prince of Wales Hospital, Chinese University of Hong Kong, Shatin.
Abstract:
We report a case of acute visual loss after a test dose (1 mg) of intravenous amphotericin B administered to a patient with systemic lupus erythematosus and with cryptococcal meningitis. Her visual acuity was normal prior to the injection of amphotericin B. The meningitis subsequently responded to miconazole and flucytosine treatment. Our findings suggest that amphotericin B should be withheld in the treatment of cryptococcal meningitis if disease of the optic nerve is strongly suspected.
Insights
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.