Cryptococcus neoformans infection as scleral abscess in a cardiac allograft recipient 6 months after heart transplantation

[Sarcoid granuloma of the iris (clinical cases and state of the problem)]

Granulomatous lesion of the iris has varying etiology, but in the differential diagnostic it should often be considered by sarcoidosis and tuberculosis damage.

PURPOSE

To describe a clinical case of sarcoid lesion of the iris and provide an analysis of literature devoted to this problem in the context of its polyetiology.

MATERIAL AND METHODS

The article describes one case of sarcoid granuloma of the iris in a young patient with a relapsing course of the disease.

RESULTS

The presented clinical case demonstrates the need for differential diagnosis to clarify the causes of the disease and the possibility of recurrence involving appearance of a multifocal lesion. The article also reviews literature on this problem reflecting the polyetiological nature of granulomatous lesions of the iris, and argues the use of interventional diagnostic methods in the absence of extraocular pathology.

CONCLUSION

Analysis of the clinical case and literature clearly demonstrates the need for differential diagnosis of granulomatous lesions of the iris.

Cryptococcal iridociliary granuloma

Cryptococcal intraocular infection is a rare disease and is usually associated with generalized systemic disease in immunocompromised patients. The diagnosis may be difficult because of the rarity of this disease and its similarities to other uveitic entities. We describe a case of culture-positive cryptococcal iridociliary granuloma diagnosed by anterior chamber tap and fine-needle aspiration biopsy in a 60-year-old immunocompetent woman with acute granulomatous uveitis. She was treated successfully with systemic amphotericin B and fluconazole and intravitreal amphotericin B, with improvement in the inflammation and visual acuity and regression of the iridociliary granuloma. We review previously reported cases of intraocular cryptococcal infection. Cryptococcal iridociliary granuloma should be considered in the differential diagnosis of an atypical iridociliary mass associated with acute uveitis.

Antifungal Management Practices and Evolution of Infection in Organ Transplant Recipients with Cryptococcus Neoformans Infection

BACKGROUND

Therapeutic practices for Cryptococcus neoformans infection in transplant recipients vary, particularly with regards to antifungal agent employed, and duration of therapy. The risk of relapse and time to recurrence is not known. We assessed antifungal treatment practices for cryptococcosis in a cohort of prospectively followed organ transplant recipients.

METHODS

The patients comprised 83 transplant recipients with cryptococcosis followed for a median of 2.1 and up to 5.2 years.

RESULTS

Patients with central nervous system infection (69% vs. 16%, P = 0.00001), disseminated infection (82.7% vs. 20%, P = 0.00001), and fungemia (29% vs. 8%, P = 0.046) were more likely to receive regimens containing amphotericin B than fluconazole as primary therapy. The use of fluconazole, on the other hand, was more likely for infection limited to the lungs (64% vs. 14%, P = 0.00002). Survival at 6 months tended to be lower in patients whose CSF cultures at 2 weeks were positive compared to those whose CSF cultures were negative (50% vs. 91%, P = 0.06). Maintenance therapy was employed in 68% (54/79) of the patients who survived >3 weeks. The median duration of maintenance therapy was 183 days; 55% received maintenance for > or = 6 months and 25% for >1 year. Relapse was documented in 1.3% (1/79) of the patients.

CONCLUSIONS

A majority of the organ transplant recipients with cryptococcosis receive maintenance antifungal therapy for 6 months with low risk of relapse. These data can assist in trials to assess the optimal therapeutic approach and duration of therapy for cryptococcosis in transplant recipients.