Case of cryptococcal choroiditis in adult with T-cell leukemia/lymphoma

Wataru Yamada; Hiroki Yamada; Kazuhiro Murata; Hiroshi Kosugi; Yuko Asano; Kiyofumi Mochizuki; Kyoko Ishida

doi:10.1016/j.jiac.2018.07.001

Case of cryptococcal choroiditis in adult with T-cell leukemia/lymphoma

J Infect Chemother. 2019 Jan;25(1):59-64. doi: 10.1016/j.jiac.2018.07.001. Epub 2018 Jul 26.

Authors

Wataru Yamada¹, Hiroki Yamada¹, Kazuhiro Murata¹, Hiroshi Kosugi², Yuko Asano³, Kiyofumi Mochizuki⁴, Kyoko Ishida⁵

Affiliations

¹ Department of Ophthalmology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki-shi, Gifu, 503-8502, Japan.
² Department of Hematology, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki-shi, Gifu, 503-8502, Japan.
³ Department of Clinical Laboratory, Ogaki Municipal Hospital, 4-86 Minaminokawa-cho, Ogaki-shi, Gifu, 503-8502, Japan.
⁴ Department of Ophthalmology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu-shi, Gifu, 501-1194, Japan.
⁵ Department of Ophthalmology, Toho University Ohashi Medical Center, 2-22-36, Ohashi, Meguro-ku, Tokyo, 153-8515, Japan. Electronic address: kyoko.ish@gmail.com.

PMID: 30057340
DOI: 10.1016/j.jiac.2018.07.001

Abstract

A rare case of 70-year-old woman with adult T-cell leukemia/lymphoma who developed multifocal choroiditis from a dissemination of Cryptococcus neoformans is reported. Ophthalmologic examination revealed multiple yellowish choroidal lesions in the posterior pole of both eyes. Sequential optical coherence tomographic images disclosed the involvement of the choroid and the consecutive changes in its architecture during the course of treatment. The recognition of these ocular manifestations may be important for the rapid diagnosis of C. nerformans-disseminated diseases. Rapid diagnosis and prompt therapy with intravitreal injection as well as systemic fosfluconazole and liposomal amphotericin B led to clinical improvement of intraocular cryptococcosis.

Keywords: Adult T-cell leukemia/lymphoma; Choroiditis; Cryptococcus neoformans; Optical coherence tomography.

Publication types

Case Reports

MeSH terms

Aged
Amphotericin B / administration & dosage
Amphotericin B / therapeutic use
Antifungal Agents / administration & dosage
Antifungal Agents / therapeutic use
Choroiditis / blood
Choroiditis / diagnosis*
Choroiditis / drug therapy
Choroiditis / microbiology
Cryptococcosis / complications
Cryptococcosis / diagnosis*
Cryptococcus neoformans / drug effects
Cryptococcus neoformans / genetics
Cryptococcus neoformans / isolation & purification*
Eye / pathology
Eye Infections, Fungal / blood
Eye Infections, Fungal / complications*
Eye Infections, Fungal / diagnosis*
Eye Infections, Fungal / drug therapy
Fatal Outcome
Female
Fluconazole / administration & dosage
Fluconazole / analogs & derivatives
Fluconazole / therapeutic use
Humans
Intravitreal Injections
Leukemia-Lymphoma, Adult T-Cell / blood
Leukemia-Lymphoma, Adult T-Cell / complications*
Leukemia-Lymphoma, Adult T-Cell / drug therapy
Multifocal Choroiditis
Organophosphates / administration & dosage
Organophosphates / therapeutic use
Tomography, Optical Coherence

Substances

Antifungal Agents
Organophosphates
liposomal amphotericin B
fosfluconazole
Amphotericin B
Fluconazole