Portelinha Joana, Passarinho Maria Picoto, Almeida Ana Catarina, Costa João Marques
Department of Ophthalmology, Hospital de Egas Moniz, Centro Hospitalar Lisboa Ocidental, Lisbon, Portugal.
BMJ Case Rep. 2014 Jun 11;2014:bcr2013203451. doi: 10.1136/bcr-2013-203451.
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.
隐球菌性脑膜炎与严重的发病率相关，在免疫功能正常的患者中较为罕见。临床表现以及病程通常较为隐匿，这可能会延迟诊断。我们报告一例52岁女性患者，因头痛、呕吐和疲劳3周入院。她被诊断为隐球菌性脑膜炎并接受了抗真菌治疗。她因左眼视力下降（OS；数指）、左侧相对性传入性瞳孔障碍和双侧第六脑神经麻痹而被转诊进行眼科检查。眼底检查显示双侧明显的视乳头水肿。头颅MRI显示颅内高压的间接征象以及多个实质病变，增强扫描后可见视神经鞘强化。进行了脑室腹腔分流术。尽管颅内压得到了控制，但右眼（OD）视力下降且视野恶化。使用静脉注射甲泼尼龙来逆转视神经病变并防止右眼视力丧失。
