Management of endogenous cryptococcal endophthalmitis with voriconazole

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    Thus, detection of toxoplasma tachyzoites from our patient’s LP was exceedingly uncommon, and likely reflective of the high burden of toxoplasma in his CNS. The standard of care for cryptococcal intraocular infection appears to be induction therapy for cryptococcal meningitis (liposomal amphotericin B and flucytosine) combined with intravitreal liposomal amphotericin B, although breakthroughs are described [28]. Treatment was initiated in our patient for cryptococcal meningitis/choroiditis and toxoplasma encephalitis, while ART was held for ∼12 weeks due to the high risk for IRIS.

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    For systemic infection, amphotericin B is required intravenously with or without flucytosine, whereas for intraocular infection, intravitreal amphotericin B is needed as there is limited intraocular penetration [3]. Our patient was successfully treated with a combination of systemic F-FLCZ and L-AMB and intravitreal injection of VRCZ OD and L-AMB OS [30]. In conclusion, when cryptococcal meningitis is present, ophthalmic examinations including OCT are recommended.

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    When positive, the culture result provides a specific etiologic diagnosis. Treatment guidelines for cryptococcosis have been published by the Infectious Diseases Society of America to guide clinicians.21 Intravenous amphotericin B is the initial treatment of choice.

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