Atchara Amphornphruet1, Sukhum Silpa-Archa1, Janine M Preble2, C Stephen Foster3,4,5. 1. a Department of Ophthalmology , Faculty of Medicine, Rajavithi Hospital, Rangsit University , Bangkok , Thailand. 2. b Wayne State University School of Medicine , Detroit , Michigan , USA. 3. c Massachusetts Eye Research and Surgery Institution , Waltham , Massachusetts , USA. 4. d Ocular Immunology & Uveitis Foundation , Waltham , Massachusetts , USA. 5. e Harvard Medical School , Boston , Massachusetts , USA.
Abstract
PURPOSE: To describe a case of bilateral endogenous cryptococcal endophthalmitis in an immunocompetent host and to review adjunctive ophthalmic imaging patterns and treatment. METHODS: A retrospective case report. RESULTS: A 45-year-old female patient with two distinct presentations of endogenous cryptococcal endophthalmitis in each eye presented initially with progressive blurred vision in the left eye, beginning more than 10 years after a craniotomy with ventriculoperitoneal shunt. Complete ophthalmic imaging was conducted and compared with data from previous literature. Administration of amphotericin-B had poorly responded; however, consolidation of fluconazole resulted in disease stabilization. CONCLUSIONS: Bilateral intraocular cryptococcal infection can present with two distinct patterns of posterior segment findings. A review of ophthalmic imaging patterns found consistency in some characteristics of A-scan ultrasonogram and fundus fluorescein angiogram. Besides conventional treatment, voriconazole is likely to play an important role in the management of cryptococcal endophthalmitis.
PURPOSE: To describe a case of bilateral endogenous cryptococcal endophthalmitis in an immunocompetent host and to review adjunctive ophthalmic imaging patterns and treatment. METHODS: A retrospective case report. RESULTS: A 45-year-old female patient with two distinct presentations of endogenous cryptococcal endophthalmitis in each eye presented initially with progressive blurred vision in the left eye, beginning more than 10 years after a craniotomy with ventriculoperitoneal shunt. Complete ophthalmic imaging was conducted and compared with data from previous literature. Administration of amphotericin-B had poorly responded; however, consolidation of fluconazole resulted in disease stabilization. CONCLUSIONS:Bilateral intraocular cryptococcal infection can present with two distinct patterns of posterior segment findings. A review of ophthalmic imaging patterns found consistency in some characteristics of A-scan ultrasonogram and fundus fluorescein angiogram. Besides conventional treatment, voriconazole is likely to play an important role in the management of cryptococcal endophthalmitis.
Authors: Keirnan L Willett; Lauren A Dalvin; Bobbi S Pritt; Madiha Fida; Mary J Kasten; Timothy W Olsen Journal: Am J Ophthalmol Case Rep Date: 2022-01-20