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Category: Volume 08 Issue 11 November 2020
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Title: Cryptococcal meningoencephalitis leading to Binocular visual loss and paraparesis in a patient with advanced HIV

Authors: Akhil Deshmukh, Amod Rajendran, Aravind Reghukumar, Athul Gurudas, Kiran Kumar

 DOI: https://dx.doi.org/10.18535/jmscr/v8i11.81

Abstract

Cryptococcus neoformans is the most common invasive fungal infection of the central nervous system in patients with advanced HIV. Neurocryptococcosis usually presents as diffuse meningoencephalitis with ocular involvement occurring as a secondary phenomenon is up to 30 % of cases. Binocular visual loss due to cryptococcal meningoencephalitis being very rare, this case report describes a patient with advanced HIV who developed binocular visual loss and paraparesis as a complication of cryptococcaemia. Even though mechanisms of visual complications in cryptococcal meningitis are still unclear, intracranial hypertension is postulated to be the primary cause while leads to delayed onset of visual loss.

Our patient had early onset of binocular painless visual loss in the absence of papilloedema Patient also had features of cryptococcal spinal arachnoiditis which manifested as asymmetric lower limb weakness with urinary retention. In view of binocular visual loss and spinal arachnoiditis, adjunctive corticosteroids were added to the treatment regime consisting of amphotericin deoxycholate and flucytosine, following which the patient made a gradual clinical recovery.

Keywords: Cryptococcal meningitis; Spinal arachnoiditis; Visual loss; Cryptococcoma; HIV.

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Corresponding Author

Aravind Reghukumar

Head of the Department of Infectious Diseases, Government Medical College, Thiruvananthapuram, Kerala, India