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. 2018 Jan 31:10:51-54.
doi: 10.1016/j.ajoc.2018.01.045. eCollection 2018 Jun.

Cryptococcal choroiditis in advanced AIDS with clinicopathologic correlation

Christopher M Aderman  1 , Ian R Gorovoy  2 , Daniel L Chao  3 , Michele M Bloomer  4 , Anthony Obeid  1 , Jay M Stewart  4
Affiliations

Cryptococcal choroiditis in advanced AIDS with clinicopathologic correlation

Christopher M Aderman et al. Am J Ophthalmol Case Rep. .

Abstract

Purpose: To describe a case of disseminated cryptococcal meningitis with multifocal choroiditis and provide optical coherence tomography (OCT) findings correlated with described histopathology in a patient with advanced acquired immunodeficiency syndrome (AIDS).

Observations: The patient was a 54-year-old man with AIDS who presented with dyspnea and headache followed by acute vision loss. OCT demonstrated a lesion with a small area of fluid that was limited by a more prominent and irregular external limiting membrane with underlying nodular choroidal thickening, mild RPE disorganization, and hyperreflectivity of the overlying photoreceptor layer. Patient was found to have disseminated cryptococcal infection and passed away despite aggressive therapy. Autopsy was performed including bilateral enucleation and a Cryptococcus lesion was confirmed on histopathology.

Conclusion and importance: This case highlights the clinical, imaging, and histopathologic findings of cryptococcal choroiditis and provides a review of the updated treatment recommendations for disseminated infection in a patient with advanced AIDS. Although currently fundoscopy has proven most useful in directing the diagnostic algorithm in choroiditis in the setting of advanced immunosuppression, OCT may provide insight into the spread of Cryptococcus within the eye.

Keywords: AIDS; Clinicopathologic correlation; Cryptococcal choroiditis; Cryptococcus neoformans; HIV; Meningitis.

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Figures

Fig. 1
Fig. 1
Color fundus photographs of multifocal choroiditis. Color fundus photographs of the right eye (A) and the left eye (B) revealed bilateral multifocal creamy yellow choroidal lesions, mild optic disc edema, and vascular tortuosity. (For interpretation of the references to colour in this figure legend, the reader is referred to the Web version of this article.)
Fig. 2
Fig. 2
Fluorescein angiogram of multifocal choroiditis. Fluorescein angiogram of the right eye showing early blockage of choroidal filling (A) mild late staining corresponding to these lesions (B).
Fig. 3
Fig. 3
Optical coherence tomography findings of choroidal lesions. Optical coherence tomography of the right macula showing a section through one of the choroidal lesions seen on fundoscopy (A). Optical coherence tomography (B) showing a small area of fluid limited by a more prominent and irregular external limiting membrane. There is underlying nodular choroidal thickening, retinal pigment epithelium disorganization and hyperreflectivity of the overlying photoreceptor later.
Fig. 4
Fig. 4
Histopathology of choroidal lesion. Gross globe (A) with higher power (B) showing multifocal choroidal infiltrates (arrows). Hematoxylin and eosin stain showing artifactual separation of the retina from the retinal pigment epithelium and choroid and a full thickness nodular choroidal lesion devoid of normal choroidal vasculature (C). Grocott's methenamine silver stain of an adjacent section (D) reveals small round organisms within the histiocytes that stain positively for Periodic acid -Schiff (E). Higher power (F) reveals budding organisms with prominent capsules (G) consistent with Cryptococcus neoformans.
See this image and copyright information in PMC

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