title: Bilateral optic neuropathy associated with cryptococcal meningitis in an immunocompetent patient.
abstract: Cryptococcal meningitis is associated with significant morbidity and is rare among immunocompetent patients. Clinical presentation as well as the course of disease is usually indolent which may delay the diagnosis. We present the case of a 52-year-old woman admitted with headaches, vomiting and fatigue for 3 weeks. She was diagnosed with cryptococcal meningitis and treated with antifungal therapy. She was referred for ophthalmological examination presenting with decreased vision in the left eye (OS; count fingers), left relative afferent pupillary defect and bilateral sixth nerve palsy. Funduscopy revealed florid bilateral papilloedema. Cranial MRI showed indirect signs of intracranial hypertension as well as multiple parenchymal lesions and optic nerve sheath enhancement after contrast administration. A ventriculoperitoneal shunt was placed. In spite of the control of intracranial pressure there was a decrease in vision in the right eye (OD) and deterioration of visual fields. Intravenous methylprednisolone was used to reverse optic neuropathy and to prevent OD visual loss.
authors.affiliation: Department of Ophthalmology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
authors.forename: Joana
authors.initials: J
authors.lastname: Portelinha
authors.affiliation: Department of Ophthalmology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
authors.forename: Maria Picoto
authors.initials: MP
authors.lastname: Passarinho
authors.affiliation: Department of Ophthalmology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
authors.forename: Ana Catarina
authors.initials: AC
authors.lastname: Almeida
authors.affiliation: Department of Ophthalmology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
authors.forename: João Marques
authors.initials: JM
authors.lastname: Costa
mesh_terms: D001766:Blindness / Q000517:prevention & control; D003455:Cryptococcus neoformans; D005260:Female; D006801:Humans; D007121:Immunocompetence / Q000502:physiology*; D019586:Intracranial Hypertension / Q000382:microbiology; D016919:Meningitis, Cryptococcal / Q000150:complications*; D008775:Methylprednisolone / Q000627:therapeutic use; D008875:Middle Aged; D018696:Neuroprotective Agents / Q000627:therapeutic use; D009901:Optic Nerve Diseases / Q000188:drug therapy / Q000382:microbiology*
chemical_list: D018696:Neuroprotective Agents; D008775:Methylprednisolone