Bilateral optic neuropathy associated with cryptococcal meningitis in an immunocompetent patient

Portelinha, Joana; Passarinho, Maria Picoto; Almeida, Ana C.; Costa, João Nunes da

doi:10.1136/bcr-2013-203451

Cited by 11 publications

(7 citation statements)

References 7 publications

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“…The mechanism may be related to arachnoid membrane adhesion, hydrocephalus, and papilledema caused by high ICP. For these patients, VP shunting may be effective for achieving a reversible recovery of consciousness, vision, and hearing, as demonstrated in the present study (Portelinha et al, 2014;Liu et al, 2014;Govender et al, 2013;McGirt et al, 2003).…”

Section: Discussionsupporting

confidence: 66%

Efficacy of ventriculoperitoneal shunting in patients with cryptococcal meningitis with intracranial hypertension

Liu

Peng

Weng

et al. 2019

International Journal of Infectious Diseases

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Background: Ventriculoperitoneal (VP) shunting in cryptococcal meningitis (CM) patients with high intracranial pressure (ICP) has been studied extensively. Methods: A total of 74 CM patients with ICP were identified, including 27 patients with or without ventriculomegaly receiving VP shunting. Results: Through retrospective analysis, there was an obvious decline in ICP as well as Cryptococcus count after VP shunting. Damage to the cranial nerves was improved after the surgery. For those patients receiving VP shunting, there was an obvious decline in ICP as well as Cryptococcus count, with less usage of mannitol. Hydrocephalus or ventriculomegaly was improved, and both the clearance time of Cryptococcus and the hospitalization time were shortened (p < 0.05). The complications of VP shunting were not common. Conclusions: For patients diagnosed with CM and with apparent ICP, VP shunting can be considered regardless of whether there is damage to the cranial nerves or hydrocephaly.

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Section: Discussionsupporting

confidence: 66%

Efficacy of ventriculoperitoneal shunting in patients with cryptococcal meningitis with intracranial hypertension

Liu

Peng

Weng

et al. 2019

International Journal of Infectious Diseases

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“…Cen-tral nervous system involvement of cryptococcosis is most likely secondary to hematologic spread. 3,13 In our case, ophthalmic involvement and diplopia were most likely secondary to the increase in intracranial pressure caused by multiple cryptococcal lesions, the presence of the intracranial infection alone, 14 or direct invasion of the fungal pathogen to the ophthalmic neurons.…”

Section: Discussionmentioning

confidence: 66%

Concurrent Persistent Cryptococcosis and Mycobacterium avium Complex Infections in a Patient With Human Immunodeficiency Virus

Joury

Alshehri

Alhasan

2018

TOJ

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Background: Fungal infections are known for their chronicity and latency and are difficult to eradicate. The pathophysiology of these invading pathogens and the resulting alteration of the immune system are not fully understood. Fungal meningitis is associated with significant rates of morbidity and mortality, especially among immunocompromised patients. Cryptococcosis, an infection secondary to the fungus Cryptococcus, is one of the most important opportunistic infections among patients with human immunodeficiency virus (HIV), and expediting treatment is crucial. Case Report: We report the case of a 28-year-old male with HIV who had a simultaneous co-infection with cryptococcal meningitis and Mycobacterium avium complex (MAC). The patient required a 2-week induction phase of antifungal medication with amphotericin B and flucytosine. Despite aggressive initial therapy and the patient's significant clinical improvement, his radiologic findings and lumbar puncture showed persistent cryptococcal infection. Conclusion: Concurrent infection with cryptococcosis and MAC is extremely rare even in immunosuppressed patients. In our case, the concurrent infection was associated with a prolonged course of therapy during the induction phase for cryptococcosis.

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“…Such impaired patients include those with a malignancy, connective tissue disorder, HIV infection or those who have undergone organ transplantation (2,14). However, previous studies have shown that a number of patients infected with Cryptococcosis are immunocompetent (6,(15)(16)(17). CM causes morbidity and mortality worldwide, particularly in patients with impaired cell-mediated immunity; however, the clinical outcomes in immunocompetent patients are more favorable.…”

Section: Discussionmentioning

confidence: 99%

“…In non-immunocompromised patients, CM typically presents with signs and symptoms associated with meningitis, such as a fever, headache and neck stiffness (3,18). Additionally, cranial neuropathies and ophthalmoplegia are common complications in patients with CM (5,6,16,19). However, primary bilateral blurred vision without any accompanying symptoms is a rare initial presentation of a cryptococcal infection.…”

Section: Discussionmentioning

confidence: 99%

Cryptococcal meningitis initially presenting with eye symptoms in an immunocompetent patient: A case report

Wang

et al. 2016

Experimental and Therapeutic Medicine

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Abstract. Although cryptococcal meningitis (CM) typically occurs in immunocompromised hosts, immunocompetent humans are susceptible to CM. In humans with an intact immune system, CM presents with signs and symptoms typical of meningitis, including fever, headache and neck stiffness. The present study reported the case of a female immunocompetent patient who presented visual blurring in both eyes and bilateral papilledema for ~1 month. Following hospital admission, the patient was diagnosed with optic nerve inflammation and was treated with intravenous methylprednisolone and oral prednisone. However, the initial symptoms failed to improve and the patient developed a headache. The microscopic examination and India ink test performed using the cerebrospinal fluid of the patient showed the presence of Cryptococcus neoformans. Following combined treatment with amphotericin B and fluconazole, the patient made a full recovery with total resolution of the initial symptoms. This case demonstrates that CM in immunocompetent patients may initially include eye symptoms, which may result in a delayed diagnosis of CM.

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Bilateral optic neuropathy associated with cryptococcal meningitis in an immunocompetent patient

Cited by 11 publications

References 7 publications

Efficacy of ventriculoperitoneal shunting in patients with cryptococcal meningitis with intracranial hypertension

Efficacy of ventriculoperitoneal shunting in patients with cryptococcal meningitis with intracranial hypertension

Concurrent Persistent Cryptococcosis and Mycobacterium avium Complex Infections in a Patient With Human Immunodeficiency Virus

Cryptococcal meningitis initially presenting with eye symptoms in an immunocompetent patient: A case report

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