Isolated Unilateral Infiltrative Cryptococcal Optic Neuropathy in an ImmunocompetentIndividual

摘要

A 46-year-old male developed painful decrease in vision in the left eye which progressed to only perception of light over a period of 2 days. A fundus examination revealed optic disc oedema and multiple white-centred haemorrhages in the left eye. The patient had no fever nor any abnormal neurological signs. Magnetic resonance imaging showed thickening of the left intraorbital and intracanalicular optic nerve with extensive perioptic enhancement. Microscopic examination of cerebrospinal fluid showed the presence of Cryptococcus neoformans. An enzyme-linked immuno-sorbent assay for human immunodeficiency virus was negative and the patient had no history of immunosuppression. A course of amphotericin B and fluconazole resolved the lesion, which was noted after imaging on subsequent visits. The authors report a hitherto undocumented entity of isolated infiltrative cryptococcal optic neuropathy in an immunocompetent individual. A fungal aetiology may be the cause of drastic loss of vision due to infiltrative optic neuropathy even in immunocompetent patients.