PRESUMED MULTIFOCAL CRYPTOCOCCOL CHOROIDOPATHY PRIOR TO SPECIFIC SYSTEMIC MANIFESTATION

Purpose: Disseminated cryptococcosis is a major cause of morbidity and mortality in immunocompromised individuals, especially those with the acquired immunodeficiency syndrome (AIDS). Early diagnosis and treatm ent greatly improves the outcome, so clinical clues that lead to promp t diagnosis are important. Methods: Three patients with AIDS in whom m ultifocal choroiditis and choroidal lesions were the initial signs of disseminated cryptococcosis were treated with systemic amphotericin B and flucytosine. Al of the patients had a systemic work-up that includ ed evaluation of the cerebral spinal fluid (CSF). Results: All three p atients who were seen with the choroidal lesions as the presenting sig n were noted to have either positive titers for cryptococcus or cultur es that grew cryptococcus in the CSF. The choroidal lesions are presum ed to be due to cryptococcus as no histopathologic or microscopic stud ies were available for ocular tissues. The choroidal lesions started t o resolve one to three months after systemic treatment with amphoteric in B and flucytosine. Conclusion: Primary choroidal lesions in patient s with AIDS may herald severe systemic disseminated disease. Funduscop ic examination, however, may detect disseminated cryptococcal disease before other overt clinical manifestations, thereby allowing prompt in stitution of effective therapy.