Abstract
Purpose :
We describe the novel clinical scenario of an AIDS patient with cryptococcal choroiditis in the absence of cryptococcal meningitis. This constellation of clinical features has never previously been reported and expands the known clinical spectrum of cryptococcal infection. We detail this unique clinical presentation, including multi-disciplinary investigative work-up, in order to educate the ophthalmologic and broader medical community with the goal of facilitating improved patient care and clinical outcomes for this life-threatening condition.
Methods :
We describe the detailed medical history and clinical presentation, along with complete laboratory work-up, including serologic, cerebrospinal, vitreous fluid analysis and neuro-imaging. This includes inpatient management for two weeks by Infectious Diseases, Dermatology and Ophthalmology. Response to anti-fungal and HAART treatment is described, along with subsequent outpatient course during three months of follow-up. Ophthalmologic imaging studies performed include slit lamp and fundus photos, macula OCT and fluorescein angiography. Additional outpatient evaluation including further vitreous fluid studies and imaging are pending following pars plana vitrectomy and cataract extraction.
Results :
The patient is a 42 year-old man who presented with decreased vision OS>OD for two weeks, along with general malaise, diffuse papular rash and mild headache. Ophthalmologic evaluation revealed bilateral panuveitis with choroidal lesions of the right eye; there was no view of the fundus of the left eye. Initial serologic work-up revealed leukopenia. Neuro-imaging showed no abnormalities. Inpatient work-up demonstrated HIV positivity and CD4 count of 30, consistent with new AIDS diagnosis. Serum cryptococcal antigen (CrAg) was positive 1:80 although cerebrospinal CrAg was negative with mild pleocytosis. CSF and vitreous cultures and skin biopsy were negative. Further analyses for other microbial etiologies were negative, including viral and bacterial. Empirical treatment for presumptive cryptococcal choroiditis without concomitant meningitis resulted in decreased bilateral uveitis and improved vision OD.
Conclusions :
We report the first known case and clinical course of cryptococcal choroiditis without meningitis. This represents an important development for diagnosing and treating this potentially life-threatening condition.
This abstract was presented at the 2019 ARVO Annual Meeting, held in Vancouver, Canada, April 28 - May 2, 2019.