Ocular Involvement in Disseminated Cryptococcosis in Advanced HIV Disease: A Case Report and Focused Literature Review

Ocular involvement is an uncommon manifestation of disseminated cryptococcosis and represents a diagnostic challenge in people with advanced HIV disease, in whom multiple opportunistic infections may coexist. We report a 46-year-old man with advanced HIV disease (CD4+ T-cell count, 12 cells/mm3) and microbiologically confirmed Cryptococcus neoformans meningitis and cryptococcemia. Persistent photophobia prompted ophthalmological evaluation, which disclosed bilateral multifocal whitish-yellow chorioretinal lesions. Optical coherence tomography demonstrated focal photoreceptor disruption and choroidal abnormalities, with corresponding choroidal flow-void areas on OCT angiography. In the absence of direct ocular microbiological or histopathological confirmation, the findings were classified as presumptive cryptococcal chorioretinitis. Systemic antifungal therapy with liposomal amphotericin B and flucytosine, followed by fluconazole consolidation, was associated with progressive anatomical regression, while visual acuity remained preserved bilaterally. A focused review of published HIV-associated cases revealed marked heterogeneity in ocular manifestations and, importantly, in the level of etiological confirmation. This case highlights the need to distinguish ophthalmological complications of cryptococcal meningitis from direct intraocular infection and to differentiate presumptive ocular involvement from microbiologically or histopathologically confirmed disease. Integrating systemic microbiological findings, exclusion of competing opportunistic infections, ophthalmological assessment, and multimodal imaging may support more rigorous etiological attribution of ocular abnormalities in disseminated cryptococcosis.