Supplementary Material for: Bilateral Cryptococcal Choroiditis in a Human Immunodeficiency Virus-Infected Patient: A Case Report

<b><i>Introduction:</i></b> In this case report, we present a rare case of bilateral cryptococcal choroiditis following a diagnosis of meningitis in a 38-year-old woman with HIV. <b><i>Case Presentation:</i></b> A Colombian woman, newly diagnosed with HIV, presented with respiratory distress followed by meningeal syndrome. Further evaluation revealed cryptococcal meningitis caused by <i>Cryptococcus neoformans</i>, confirmed through cerebrospinal fluid analysis and brain magnetic resonance imaging. The patient reported mild blurred vision, prompting an ophthalmic examination that included indocyanine green angiography. The findings revealed signs of HIV retinopathy and multifocal choroidal lesions in both eyes, suggestive of choroidal cryptococcosis. Treatment involved intravenous administration of amphotericin B and flucytosine, followed by oral fluconazole. Subsequently, the choroidal lesions gradually regressed, and regular monitoring demonstrated no signs of recurrence. <b><i>Conclusion:</i></b> Cryptococcal choroiditis, though exceptionally rare, can occur in HIV-positive patients with disseminated cryptococcosis. Ophthalmologists should maintain a high index of suspicion for opportunistic infections, even in the absence of pronounced ocular symptoms, particularly in immunocompromised individuals. Early diagnosis and appropriate treatment are crucial for achieving favorable outcomes in such cases.

<b><i>引言：</i></b> 本病例报告报道1例38岁人类免疫缺陷病毒（HIV）阳性女性，在确诊脑膜炎后并发双侧隐球菌性脉络膜炎（cryptococcal choroiditis）的罕见病例。
<b><i>病例介绍：</i></b> 一名新诊断人类免疫缺陷病毒（HIV）感染的哥伦比亚女性，先出现呼吸窘迫，随后出现脑膜综合征。进一步检查通过脑脊液（cerebrospinal fluid）分析及脑部磁共振成像（brain magnetic resonance imaging），确诊为新生隐球菌（Cryptococcus neoformans）引发的隐球菌性脑膜炎（cryptococcal meningitis）。患者自述存在轻度视物模糊，遂接受包含吲哚菁绿血管造影（indocyanine green angiography）的眼科检查。检查结果显示双眼存在HIV视网膜病变（HIV retinopathy）及多灶性脉络膜病变，提示脉络膜隐球菌病。治疗方案为静脉滴注两性霉素B（amphotericin B）与氟胞嘧啶（flucytosine），后续予口服氟康唑（fluconazole）治疗。后续随访可见脉络膜病变逐渐消退，定期监测未发现复发迹象。
<b><i>结论：</i></b> 隐球菌性脉络膜炎虽极为罕见，但可发生于伴播散性隐球菌病的人类免疫缺陷病毒（HIV）阳性患者中。眼科医师应高度警惕机会性感染（opportunistic infections），即便无明显眼部症状，尤其针对免疫功能低下个体（immunocompromised individuals）。此类病例的早期诊断与合理治疗对获得良好预后至关重要。