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Photo Essay
November 2004

Bilateral Cryptococcal Choroiditis

Arch Ophthalmol. 2004;122(11):1726-1727. doi:10.1001/archopht.122.11.1726

A 44-year-old African American woman with AIDS was examined becauseof blurry vision, photophobia, headaches, and a papular rash on the face,trunk, and extremities of 1 week’s duration. Her medical history included Pneumocystis carinii pneumonia, untreated Cryptococcus neoformans fungemia, recurrent episodes of Candida esophagitis, and hepatitis C infection. She was unable to complywith visual acuity or confrontational field testing. Intraocular pressurewas 21 mm Hg OD and 54 mm Hg OS. Pupils were reactive without an afferentpupillary defect. External examination disclosed multiple cutaneous papulesof the periorbital area and face (Figure 1).Slitlamp examination was significant for microcystic edema of the left cornea,but there was no anterior chamber inflammation or anterior vitritis. Dilatedfundus examination showed multiple bilateral, yellow-white choroidal lesionswith indistinct borders, approximately 0.5 to 1.5 disc diameters in size,and intraretinal hemorrhages (Figure 2).Fluorescein angiography showed blocked fluorescence from the choroidal lesions.

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