Custis P H, Haller J A, de Juan E
Wilmer Ophthalmological Institute, Johns Hopkins University, Baltimore, Maryland, USA.
Retina. 1995;15(4):300-4. doi: 10.1097/00006982-199515040-00006.
Cryptococcal endophthalmitis is a rare disorder, almost invariably diagnosed after enucleation or at postmortem examination. There are therefore few guidelines as to its identification or treatment.
A case of culture-positive cryptococcal endophthalmitis in a patient with chronic uveitis was diagnosed by vitreous biopsy at the time of retinal detachment repair. The patient was treated with oral fluconazole for 5 months. All reported cases of cryptococcal endophthalmitis were reviewed and compared.
After oral fluconazole therapy, the patient was culture negative on repeat tap. Despite conversion to culture-negative status, however, visual acuity declined to hand motions because of hyphema and hypotony. The organism was successfully identified as a non-neoformans species, Cryptococcus laurentii, previously unreported as an ocular pathogen.
This unique case demonstrates that cryptococcal disease can be diagnosed antemortem by vitreous biopsy, and should be added to the differential diagnosis in cases of chronic smoldering uveitis. A non-neoformans organism is also identified for the first time as a cause of ocular cryptococcosis. Fluconazole, used here for the only time of which we are aware to treat cryptococcal endophthalmitis, produced successful conversion to culture negativity and resolution of the uveitis.
隐球菌性眼内炎是一种罕见疾病，几乎总是在眼球摘除术后或尸检时才得以诊断。因此，关于其识别和治疗的指南很少。
一名患有慢性葡萄膜炎的患者在视网膜脱离修复时通过玻璃体活检被诊断为培养阳性的隐球菌性眼内炎。该患者接受了5个月的口服氟康唑治疗。对所有已报道的隐球菌性眼内炎病例进行了回顾和比较。
口服氟康唑治疗后，再次抽取玻璃体检查时患者培养结果转为阴性。然而，尽管培养结果转为阴性，但由于前房积血和低眼压，视力下降至手动。该病原体被成功鉴定为非新型隐球菌种，即罗伦隐球菌，此前未被报道为眼部病原体。
这一独特病例表明，隐球菌病可通过玻璃体活检进行生前诊断，在慢性隐匿性葡萄膜炎病例的鉴别诊断中应将其纳入考虑。一种非新型隐球菌生物体也首次被确定为眼部隐球菌病的病因。氟康唑在此用于治疗隐球菌性眼内炎，据我们所知这是唯一一次使用，成功使培养结果转为阴性并使葡萄膜炎得到缓解。
