Bilateral Cryptococcal Choroiditis in a Human Immunodeficiency Virus-Infected Patient: A Case Report

Area of Science:

• Ophthalmology
• Infectious Diseases
• Immunology

Background:

• Cryptococcal meningitis is a serious opportunistic infection in individuals with Human Immunodeficiency Virus (HIV).
• Ocular manifestations of disseminated cryptococcosis, such as choroiditis, are rare but can occur in immunocompromised patients.
• Early recognition and management are critical for preventing vision loss and systemic complications.

Observation:

• A 38-year-old woman with newly diagnosed HIV presented with respiratory distress and cryptococcal meningitis.
• Ophthalmic examination revealed HIV retinopathy and bilateral multifocal choroidal lesions consistent with cryptococcal choroiditis.
• Indocyanine green angiography aided in the diagnosis of the choroidal lesions.

Findings:

• Cerebrospinal fluid analysis and brain MRI confirmed cryptococcal meningitis caused by Cryptococcus neoformans.
• Intravenous amphotericin B and flucytosine, followed by oral fluconazole, were administered for treatment.
• The patient showed gradual regression of choroidal lesions and no recurrence during follow-up.

Implications:

• This case underscores the importance of ophthalmologic evaluation in HIV-positive patients with cryptococcal meningitis, even with subtle visual symptoms.
• Ophthalmologists must consider opportunistic infections like cryptococcal choroiditis in immunocompromised individuals.
• Timely diagnosis and comprehensive treatment are essential for favorable visual outcomes and managing disseminated fungal infections.