Bilateral optic neuropathy in acute cryptococcal meningitis

We reported a case of cryptococcal meningitis presenting with bilateral optic neuropathy\udin an immunocompetent patient. A 64-year-old Malay gentleman with no medical\udcomorbidities presented with acute bilateral blurring of vision for a week, which was\udassociated with generalised throbbing headache and low grade fever. He also had somnolence and altered consciousness. Visual acuity in both eyes was no perception of light\udwith poor pupillary reflexes. Extraocular muscle movements were normal. Anterior\udsegments were unremarkable bilaterally. Fundoscopy revealed bilateral optic disc\udswelling. CT scan of the brain showed multifocal infarct, but no meningeal enhancement\udor mass. Cerebrospinal fluid opening pressure was normal, while its culture grew\udCryptococcus neoformans. A diagnosis of cryptococcal meningitis with bilateral optic\udneuropathy was made. Patient was treated with a six-week course of intravenous fluconazole and started concomitantly on a fortnight's course of intravenous amphotericin B.\udAfter that, his general condition improved, but there was still no improvement in his\udvisual acuity. On reviewing at two months post-initiation of treatment, fundi showed\udbilateral optic atrophy. Bilateral optic neuropathy secondary to cryptococcal meningitis\udwas rare. The prognosis was guarded due to the sequelae of optic atrophy. Anti-fungal\udmedication alone may not be sufficient to manage this condition. However, evidence\udfor other treatment modalities is still lacking and further clinical studies are required