Neuro-ophthalmic presentations and treatment of Cryptococcal meningitis-related increased intracranial pressure

Can J Ophthalmol. 2014 Oct;49(5):473-7. doi: 10.1016/j.jcjo.2014.06.012.


Objective: To illustrate three different ophthalmic presentations of cryptococcal meningitis (CM).

Introduction: CM is the most common manifestation of extra-pulmonary cryptococcosis. Intracranial hypertension occurs in up to 75% of patients with CM and is associated with increased mortality. CM can present to the ophthalmologist as vision loss, papilledema, abducens palsy, and/or other cranial neuropathies.

Participants and methods: We report three cases, two C. neoformans and one C. gattii, highlighting the various CM presentations. The first was a woman immunosuppressed following kidney transplantation in whom idiopathic intracranial hypertension (IIH) was initially suspected. The second was a man immunocompromised by previously undiagnosed HIV/AIDS who presented with signs and symptoms of increased intracranial pressure. The third case is an immunocompetent man with bilateral disc edema and an incomplete macular star diagnosed with presumed neuroretinitis. Further evaluation revealed positive CSF cryptococcal antigen with culture positive for C. gattii.

Conclusions: Ophthalmologists should be aware that cryptococcosis can mimic more benign etiologies including IIH and neuroretinitis. Additionally, C. gattii, an emerging organism, can infect immunocompetent patients. In contrast to the typical treatment of increased ICP, serial lumbar punctures are recommended while acetazolamide and surgical CSF shunting may be harmful.

Publication types

  • Case Reports

MeSH terms

  • Amphotericin B / therapeutic use
  • Antibodies, Fungal / cerebrospinal fluid
  • Antifungal Agents / therapeutic use*
  • Antigens, Fungal / immunology
  • Cryptococcosis / diagnosis*
  • Cryptococcosis / drug therapy
  • Cryptococcus gattii / immunology
  • Cryptococcus gattii / isolation & purification
  • Cryptococcus neoformans / immunology
  • Cryptococcus neoformans / isolation & purification
  • Drug Therapy, Combination
  • Eye Infections, Fungal / diagnosis*
  • Eye Infections, Fungal / drug therapy
  • Eye Infections, Fungal / microbiology
  • Female
  • Flucytosine / therapeutic use
  • Humans
  • Intracranial Hypertension / diagnosis*
  • Intracranial Hypertension / drug therapy
  • Intracranial Hypertension / microbiology
  • Intracranial Pressure
  • Male
  • Meningitis, Cryptococcal / diagnosis*
  • Meningitis, Cryptococcal / drug therapy
  • Meningitis, Cryptococcal / microbiology
  • Optic Neuritis / diagnosis*
  • Optic Neuritis / drug therapy
  • Optic Neuritis / microbiology
  • Papilledema / diagnosis*
  • Papilledema / drug therapy
  • Papilledema / microbiology


  • Antibodies, Fungal
  • Antifungal Agents
  • Antigens, Fungal
  • Amphotericin B
  • Flucytosine