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Cryptococcal endophthalmitis and meningitis in an immunocompetent middle-aged woman: A case report
Guo Tang1, Hao Li2, Chen Liang3
1Emergency Departments of West China Hospital, Sichuan University, Cheng Du, Sichuan, China.
Abstract:
Cryptococcus neoformans is a global invasive mycosis that is known to cause significant morbidity and mortality. It is commonly observed that individuals with compromised immune systems are more prone to developing cryptococcal meningitis. Although ocular involvement is rare, previous studies have indicated that ocular lesions precede symptomatic meningitis in only 27 % of patients with central nervous system involvement. Intraocular infections typically manifest as chorioretinopathy and vitreous inflammation, often leading to severe vision loss. In this case, we present the clinical details of a 57-year-old immunocompetent woman who visited the ophthalmology department of West China Hospital of Sichuan University with a progressive loss of vision in her right eye. After a thorough evaluation, she was diagnosed with fungal endophthalmitis, and subsequently initiated on appropriate induction anti-fungal therapy for cryptococcal meningoencephalitis. This case highlights the importance of early recognition and treatment, which can potentially improve the prognosis for patients.
Insights
This case report details a rare instance of cryptococcal meningoencephalitis presenting as fungal endophthalmitis in an immunocompetent patient. Early diagnosis and treatment are crucial for improving outcomes in this invasive fungal infection.
Area of Science:
- Ophthalmology
- Infectious Diseases
- Mycology
Background:
- Cryptococcus neoformans causes invasive fungal infections, primarily affecting immunocompromised individuals.
- Cryptococcal meningitis is a serious condition with significant mortality.
- Ocular involvement in cryptococcosis is rare, with intraocular lesions preceding meningitis in a minority of cases.
Observation:
- A 57-year-old immunocompetent woman presented with progressive vision loss in her right eye.
- Ophthalmological examination revealed fungal endophthalmitis.
- The patient was diagnosed with cryptococcal meningoencephalitis.
Findings:
- The case demonstrates a rare presentation of cryptococcal meningoencephalitis.
- Fungal endophthalmitis can be an early sign of central nervous system cryptococcal infection.
- Immunocompetent individuals can be affected by invasive cryptococcosis.
Implications:
- Early recognition of ocular symptoms is vital for timely diagnosis of cryptococcal meningoencephalitis.
- Prompt anti-fungal therapy can improve the prognosis for patients with cryptococcal infections.
- This case underscores the need for a high index of suspicion for invasive fungal infections, even in immunocompetent hosts.
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