Prominent papilledema with dense peripapillary hemorrhage in AIDS patients with cryptococcal meningitis

Abstract Background: To describe the clinical characteristics of prominent papilledema with dense peripapillary hemorrhage in AIDS patients with cryptococcal meningitis. Case presentation: Case1. A 35-year-old male with acquired immune deficiency syndrome (AIDS) complicated with cryptococcal meningitis had a severely visual loss in both eyes after 33 days of highly active anti-retroviral therapy (HAART). Funduscopic examination revealed marked bilateral papilledema with dense peripapillary hemorrhages and macular exudates. The patient was treated with intravenous mannitol and intermittent lumbar punctures. His vision was improved after 4 months of treatment. Case2. A 43-year-old male with AIDS suffered from severe vision deterioration in both eyes. He has not accepted HAART at that time. Dilated fundoscopic examination revealed marked disk edema with dense peripapillary hemorrhages in his right eye and mild papilledema with slight peripapillary hemorrhages in his left eye. The diagnosis of cryptococcal meningitis was made. His BCVA didn’t improve after treatment. He died 3 months after the hospitalization. Conclusion: Prominent papilledema with dense peripapillary hemorrhage is uncommon, which maybe the sign of an opportunistic infectious associated with IRIS or the sign of poor prognosis in AIDS patients with cryptococcal meningitis. Keywords: Papilledema, AIDS, cryptococcal meningitis