AIDS-related Cryptococcus neoformans choroiditis

Area of Science:

• Ophthalmology
• Infectious Diseases
• Immunology

Background:

• Cryptococcal meningoencephalitis is a common opportunistic infection in patients with advanced Human Immunodeficiency Virus (HIV)/Acquired Immunodeficiency Syndrome (AIDS).
• Ocular manifestations of cryptococcosis, such as choroiditis, are rare but can lead to significant visual impairment.

Observation:

• A 29-year-old male with advanced HIV/AIDS presented with symptoms of cryptococcal and toxoplasma meningoencephalitis, including fever, photophobia, and ataxia.
• Ophthalmologic examination revealed bilateral, multifocal posterior infiltrates indicative of cryptococcal choroiditis.

Findings:

• The patient received a combination treatment regimen including parenteral and intravitreal liposomal amphotericin B, oral flucytosine, and oral trimethoprim-sulfamethoxazole.
• This therapeutic approach resulted in the resolution of neurological symptoms and improvement in visual function.

Implications:

• This case underscores the importance of comprehensive ophthalmologic evaluation in immunocompromised patients presenting with visual disturbances and invasive fungal infections.
• Early diagnosis and multi-modal treatment are essential for managing cryptococcal choroiditis and preventing vision loss in HIV/AIDS patients.
• The case highlights the need for increased awareness of rare opportunistic intraocular infections in the context of advanced HIV/AIDS.