Reversible visual disturbance due to cryptococcal uveitis in a non-HIV individual.
A 52-year-old man without underlying diseases visited a local hospital with symptoms of memory deficit and mild headache. Radiological examination of the brain with computed tomography (CT) revealed hydrocephalus. Etiology was not revealed by cerebrospinal fluid (CSF) analysis and a ventricular-atrial (V-A) shunt was installed. The patient had congestion and dacryorrhea of the right eye and uveitis was diagnosed three months after placement of the V-A shunt. The serum cryptococcal antigen (CrAg) tested positive at a titration of 64 times. Additionally, samples of the right eye anterior chamber aqueous humor (ACAH), cerebrospinal fluid (CSF) and prostate fluid were positive for Cryptococcus antigen at a titration of 128 times. In addition, Cryptococcus neoformans var. grubii was isolated from the peripheral blood, CSF and ACAH, resulting in a diagnosis of disseminated cryptococcosis. Fluconazole (FLCZ) at 800 mg/day was administered for the first two days, followed by a 400 mg/day maintenance dose. After six months of treatment, his visual power recovered. This is a rare case of disseminated cryptococcosis involving uveitis, which was successfully treated by FLCZ. Disseminated cryptococcosis should be considered in cases with mild symptoms and V-A shunt installation for hydrocephalus.
Nakamura
Shigeki
S
Second Department of Internal Medicine, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan.
Izumikawa
Koichi
K
Seki
Masafumi
M
Fujimoto
Kyoko
K
Mishima
Kazuaki
K
Kakeya
Hiroshi
H
Yamamoto
Yoshihiro
Y
Yanagihara
Katsunori
K
Mizuta
Yohei
Y
Kitaoka
Takashi
T
Kohno
Shigeru
S
D000935:Antifungal Agents / Q000627:therapeutic use; D002557:Cerebrospinal Fluid Shunts; D003453:Cryptococcosis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D009877:Endophthalmitis / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D015725:Fluconazole / Q000627:therapeutic use; D018023:HIV Seronegativity; D006801:Humans; D006849:Hydrocephalus / Q000150:complications; D008297:Male; D016919:Meningitis, Cryptococcal / Q000150:complications / Q000175:diagnosis* / Q000188:drug therapy; D008875:Middle Aged; D014786:Vision Disorders / Q000209:etiology / Q000382:microbiology
D000935:Antifungal Agents; D015725:Fluconazole