Cryptococcal meningitis initially presenting with eye symptoms in an immunocompetent patient: A case report

Li,Jun; Wang,Peipei; Ye,Ling; Wang,Yanfang; Zhang,Xiuzhen; Yu,Songping

doi:10.3892/etm.2016.3440

Cryptococcal meningitis initially presenting with eye symptoms in an immunocompetent patient: A case report

Authors:
- Jun Li
- Peipei Wang
- Ling Ye
- Yanfang Wang
- Xiuzhen Zhang
- Songping Yu
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Affiliations: Department of Ophthalmology, Lishui Hospital Affiliated to Zhejiang University, Lishui, Zhejiang 323000, P.R. China, Department of Stomatology, Lishui Hospital Affiliated to Zhejiang University, Lishui, Zhejiang 323000, P.R. China
Published online on: June 8, 2016 https://doi.org/10.3892/etm.2016.3440
Pages: 1119-1124

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Abstract

Although cryptococcal meningitis (CM) typically occurs in immunocompromised hosts, immunocompetent humans are susceptible to CM. In humans with an intact immune system, CM presents with signs and symptoms typical of meningitis, including fever, headache and neck stiffness. The present study reported the case of a female immunocompetent patient who presented visual blurring in both eyes and bilateral papilledema for ~1 month. Following hospital admission, the patient was diagnosed with optic nerve inflammation and was treated with intravenous methylprednisolone and oral prednisone. However, the initial symptoms failed to improve and the patient developed a headache. The microscopic examination and India ink test performed using the cerebrospinal fluid of the patient showed the presence of Cryptococcus neoformans. Following combined treatment with amphotericin B and fluconazole, the patient made a full recovery with total resolution of the initial symptoms. This case demonstrates that CM in immunocompetent patients may initially include eye symptoms, which may result in a delayed diagnosis of CM.

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1	Park BJ, Wannemuehler KA, Marston BJ, Govender N, Pappas PG and Chiller TM: Estimation of the current global burden of cryptococcal meningitis among persons living with HIV/AIDS. AIDS. 23:525–530. 2009. View Article : Google Scholar : PubMed/NCBI
2	Sloan DJ and Parris V: Cryptococcal meningitis: Epidemiology and therapeutic options. Clin Epidemiol. 6:169–182. 2014. View Article : Google Scholar : PubMed/NCBI
3	Chen SC, Slavin MA, Heath CH, Playford EG, Byth K, Marriott D, Kidd SE, Bak N, Currie B, Hajkowicz K, et al: Australia and New Zealand Mycoses Interest Group (ANZMIG)-Cryptococcus Study: Clinical manifestations of Cryptococcus gattii infection: Determinants of neurological sequelae and death. Clin Infect Dis. 55:789–798. 2012. View Article : Google Scholar : PubMed/NCBI
4	Pappalardo MC, Szeszs MW, Martins MA, Baceti LB, Bonfietti LX, Purisco SU, Baez AA and Melhem MS: Susceptibility of clinical isolates of Cryptococcus neoformans to amphotericin B using time-kill methodology. Diagn Microbiol Infect Dis. 64:146–151. 2009. View Article : Google Scholar : PubMed/NCBI
5	Muslikhan Y, Hitam WH, Ishak SR, Mohtar I and Takaran J: Cryptococcus meningitis in an immunocompetent teenage boy presented early with diplopia. Int J Ophthalmol. 3:92–94. 2010.PubMed/NCBI
6	Liyanage DS, Pathberiya LP, Gooneratne IK, Caldera MH, Perera PW and Gamage R: Cryptococcal meningitis presenting with bilateral complete ophthalmoplegia: A case report. BMC Res Notes. 7:3282014. View Article : Google Scholar : PubMed/NCBI
7	Moodley A, Rae W, Bhigjee A, Connolly C, Devparsad N, Michowicz A, Harrison T and Loyse A: Early clinical and subclinical visual evoked potential and Humphrey's visual field defects in cryptococcal meningitis. PloS One. 7:e528952012. View Article : Google Scholar : PubMed/NCBI
8	Saha DC, Xess I and Jain N: Evaluation of conventional & serological methods for rapid diagnosis of cryptococcosis. Indian J Med Res. 127:483–488. 2008.PubMed/NCBI
9	Leal AL, Faganello J, Fuentefria AM, Boldo JT, Bassanesi MC and Vainstein MH: Epidemiological profile of cryptococcal meningitis patients in Rio Grande do Sul, Brazil. Mycopathologia. 166:71–75. 2008. View Article : Google Scholar : PubMed/NCBI
10	Pyrgos V, Seitz AE, Steiner CA, Prevots DR and Williamson PR: Epidemiology of cryptococcal meningitis in the US: 1997–2009. PloS One. 8:e562692013. View Article : Google Scholar : PubMed/NCBI
11	Perfect JR and Casadevall A: Cryptococcosis. Infecti Dis Clin North Am. 16:837–874. 2002. View Article : Google Scholar
12	Corti M, Solari R, Cangelosi D, Domínguez C, Yampolsky C, Negroni R, Arechavala A and Schtirbu R: Sudden blindness due to bilateral optic neuropathy associated with cryptococcal meningitis in an AIDS patient. Rev Iberoam Micol. 27:207–209. 2010. View Article : Google Scholar : PubMed/NCBI
13	Schimpff SC and Bennett JE: Abnormalities in cell-mediated immunity in patients with Cryptococcus neoformans infection. J Allergy Clin Immunol. 55:430–441. 1975. View Article : Google Scholar : PubMed/NCBI
14	Gonzalez-Duarte A, Saniger-Alba Mdel M and Higuera-Calleja J: Cryptococcal meningitis in HIV-negative patients with systemic connective tissue diseases. Neurol Res. 37:283–287. 2015. View Article : Google Scholar : PubMed/NCBI
15	Louro R, Ferreira R, Pinheiro C, Parada H, Faria D and Monteiro E: Fungal meningitis in an immunocompetent patient. Clin Drug Investig. 33(Suppl 1): S47–S50. 2013. View Article : Google Scholar : PubMed/NCBI
16	Portelinha J, Passarinho MP, Almeida AC and Costa JM: Bilateral optic neuropathy associated with cryptococcal meningitis in an immunocompetent patient. BMJ Case Rep. 2014:pii2014.
17	Saigal G, Post MJ, Lolayekar S and Murtaza A: Unusual presentation of central nervous system cryptococcal infection in an immunocompetent patient. AJNR. Am J Neuroradiol. 26:2522–2526. 2005.PubMed/NCBI
18	McMullan BJ, Sorrell TC and Chen SC: Cryptococcus gattii infections: Contemporary aspects of epidemiology, clinical manifestations and management of infection. Future Microbiol. 8:1613–1631. 2013. View Article : Google Scholar : PubMed/NCBI
19	Espino Barros Palau A, Morgan ML, Foroozan R and Lee AG: Neuro-ophthalmic presentations and treatment of Cryptococcal meningitis-related increased intracranial pressure. Can J Ophthalmol. 49:473–477. 2014. View Article : Google Scholar : PubMed/NCBI
20	Khairullah S, Sulaiman H, Yahya F, Jasmin R, Cheah TE, Sockalingam S, Bick J and Chin Teck NG: Cryptococcal meningitis and SLE: A diagnostic and therapeutic challenge. Acta Reumatol Port. 39:254–258. 2014.PubMed/NCBI
21	Patil SA, Katyayani S and Arvind N: Significance of antibody detection in the diagnosis of cryptococcal meningitis. J Immunoassay Immunochem. 33:140–148. 2012. View Article : Google Scholar : PubMed/NCBI
22	Sarkis RA, Mays M, Isada C and Ahmed M: MRI findings in cryptococcal meningitis of the non-HIV population. Neurologist. 19:40–45. 2015. View Article : Google Scholar : PubMed/NCBI
23	Day JN, Chau TT, Wolbers M, Mai PP, Dung NT, Mai NH, Phu NH, Nghia HD, Phong ND, Thai CQ, et al: Combination antifungal therapy for cryptococcal meningitis. N Engl J Med. 368:1291–1302. 2013. View Article : Google Scholar : PubMed/NCBI
24	Lui G, Lee N, Ip M, Choi KW, Tso YK, Lam E, Chau S, Lai R and Cockram CS: Cryptococcosis in apparently immunocompetent patients. QJM. 99:143–151. 2006. View Article : Google Scholar : PubMed/NCBI