title: Neuro-ophthalmic presentations and treatment of Cryptococcal meningitis-related increased intracranial pressure.
abstract: OBJECTIVE
  To illustrate three different ophthalmic presentations of cryptococcal meningitis (CM).
  
  
  BACKGROUND
  CM is the most common manifestation of extra-pulmonary cryptococcosis. Intracranial hypertension occurs in up to 75% of patients with CM and is associated with increased mortality. CM can present to the ophthalmologist as vision loss, papilledema, abducens palsy, and/or other cranial neuropathies.
  
  
  METHODS
  We report three cases, two C. neoformans and one C. gattii, highlighting the various CM presentations. The first was a woman immunosuppressed following kidney transplantation in whom idiopathic intracranial hypertension (IIH) was initially suspected. The second was a man immunocompromised by previously undiagnosed HIV/AIDS who presented with signs and symptoms of increased intracranial pressure. The third case is an immunocompetent man with bilateral disc edema and an incomplete macular star diagnosed with presumed neuroretinitis. Further evaluation revealed positive CSF cryptococcal antigen with culture positive for C. gattii.
  
  
  CONCLUSIONS
  Ophthalmologists should be aware that cryptococcosis can mimic more benign etiologies including IIH and neuroretinitis. Additionally, C. gattii, an emerging organism, can infect immunocompetent patients. In contrast to the typical treatment of increased ICP, serial lumbar punctures are recommended while acetazolamide and surgical CSF shunting may be harmful.
authors.affiliation: Department of Ophthalmology, Houston Methodist Hospital, Houston, Tex.
authors.forename: Angelina
authors.initials: A
authors.lastname: Espino Barros Palau
authors.affiliation: Department of Ophthalmology, Houston Methodist Hospital, Houston, Tex.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Morgan
authors.affiliation: Baylor College of Medicine, Houston, Tex.
authors.forename: Rod
authors.initials: R
authors.lastname: Foroozan
authors.affiliation: Department of Ophthalmology, Houston Methodist Hospital, Houston, Tex; Baylor College of Medicine, Houston, Tex; Departments of Ophthalmology, Neurology, and Neurosurgery, Weill Cornell Medical College, Houston, Tex; UTMB Galveston, Galveston; UT M.D. Anderson Cancer Center, Houston, Tex; The University of Iowa Hospitals and Clinics, Iowa City, Iowa. Electronic address: AGLee@HoustonMethodist.org.
authors.forename: Andrew G
authors.initials: AG
authors.lastname: Lee
mesh_terms: D000666:Amphotericin B / Q000627:therapeutic use; D000908:Antibodies, Fungal / Q000134:cerebrospinal fluid; D000935:Antifungal Agents / Q000627:therapeutic use*; D000946:Antigens, Fungal / Q000276:immunology; D003453:Cryptococcosis / Q000175:diagnosis* / Q000188:drug therapy; D056285:Cryptococcus gattii / Q000276:immunology / Q000302:isolation & purification; D003455:Cryptococcus neoformans / Q000276:immunology / Q000302:isolation & purification; D004359:Drug Therapy, Combination; D015821:Eye Infections, Fungal / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D005260:Female; D005437:Flucytosine / Q000627:therapeutic use; D006801:Humans; D019586:Intracranial Hypertension / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D007427:Intracranial Pressure; D008297:Male; D016919:Meningitis, Cryptococcal / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D009902:Optic Neuritis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D010211:Papilledema / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology
chemical_list: D000908:Antibodies, Fungal; D000935:Antifungal Agents; D000946:Antigens, Fungal; D000666:Amphotericin B; D005437:Flucytosine