Presumed bilateral endogenous Cryptococcus neoformans endophthalmitis with concomitant Toxoplasma gondii retinochoroiditis

Shane Griffin; Neeraj Chawla; Lawrence Chan; Anita Agarwal; Gaurav Shah

doi:10.1016/j.ajoc.2025.102364

Presumed bilateral endogenous Cryptococcus neoformans endophthalmitis with concomitant Toxoplasma gondii retinochoroiditis

Am J Ophthalmol Case Rep. 2025 Jun 11:39:102364. doi: 10.1016/j.ajoc.2025.102364. eCollection 2025 Sep.

Authors

Shane Griffin¹, Neeraj Chawla¹, Lawrence Chan^{1

2}, Anita Agarwal^{1

2}, Gaurav Shah^{1

2}

Affiliations

¹ California Pacific Medical Center Department of Ophthalmology, San Francisco, CA, USA.
² West Coast Retina Medical Group, San Francisco, CA, USA.

Abstract

Purpose: To report a case of bilateral endogenous Cryptococcus endophthalmitis with Toxoplasma retinochoroiditis.

Observations: A 57-year-old woman with history of renal transplantation developed Cryptococcus neoformans fungemia and meningitis. Reporting bilateral blurry vision, she was found to have associated bilateral endophthalmitis suspicious for endogenous cryptococcal endophthalmitis that was initially responsive to intravitreal voriconazole injections but subsequently worsened despite systemic and intraocular anti-fungal treatments. Given her refractory disease, additional testing was performed, which revealed added infection with Toxoplasma gondii. She underwent bilateral vitrectomy with povidone-iodine infusion and systemic parasiticidal treatment with improvement and stability of her condition.

Conclusions and importance: Immunocompromised hosts are at risk for infection with multiple opportunistic infections that may require broad testing and aggressive medical and surgical therapies.

Keywords: Cryptococcus neoformans; Endogenous endophthalmitis; Immunocompromised; Opportunistic infection; Toxoplasma gondii.

Publication types

Case Reports