DOI QR코드

DOI QR Code

Fatal Case of Cerebral Aspergillosis : A Case Report and Literature Review

  • Lee, Jae-Chang (Department of Neurosurgery, Korea University Medical Center) ;
  • Lim, Dong-Jun (Department of Neurosurgery, Korea University Medical Center) ;
  • Ha, Sung-Kon (Department of Neurosurgery, Korea University Medical Center) ;
  • Kim, Sang-Dae (Department of Neurosurgery, Korea University Medical Center) ;
  • Kim, Se-Hoon (Department of Neurosurgery, Korea University Medical Center)
  • Received : 2012.06.21
  • Accepted : 2012.10.10
  • Published : 2012.10.28

Abstract

Cerebral aspergillosis is rare and usually misdiagnosed because its presentation is similar to that of a tumor. The correct diagnosis is usually made intra-operatively. Cerebral abscess with fungal infection is extremely rare and few cases have been reported, but it carries a poor prognosis. A 73 year-old man presented with decreased visual acuity and paresis of the right cranial nerve III. Magnetic resonance imaging (MRI) revealed a mass in the right cavernous sinus, extened to the anterior crainial fossa and the superior orbital fissure. During surgery, a well encapsulated pus pocket was found, and histopathological examination of the mass resulted in the diagnosis of aspergillosis. Despite appropriate anti-fungal treatment, the patient eventually died from fatal cerebral ischemic change and severe brain swelling. The correct diagnosis of cerebral aspergillosis can only be achieved by histopathological examination because clinical and radiological findings including MRI are not specific. Surgical intervention and antifungal therapy should be considered the optimal treatment. Early diagnosis and aggressive antifungal treatment provide good results.

Keywords

References

  1. Alapatt JP, Kutty RK, Gopi PP, Challissery J : Middle and posterior fossa aspergilloma. Surg Neurol 66 : 75-78; discussion 78-79, 2006 https://doi.org/10.1016/j.surneu.2005.11.061
  2. Bodey G, Bueltmann B, Duguid W, Gibbs D, Hanak H, Hotchi M, et al. : Fungal infections in cancer patients : an international autopsy survey. Eur J Clin Microbiol Infect Dis 11 : 99-109, 1992 https://doi.org/10.1007/BF01967060
  3. Endo T, Numagami Y, Jokura H, Ikeda H, Shirane R, Yoshimoto T : Aspergillus parasellar abscess mimicking radiation-induced neuropathy. Case report. Surg Neurol 56 : 195-200, 2001 https://doi.org/10.1016/S0090-3019(01)00488-8
  4. Gupta AK, Mann SB, Khosla VK, Sastry KV, Hundal JS : Non-randomized comparison of surgical modalities for paranasal sinus mycoses with intracranial extension. Mycoses 42 : 225-230, 1999 https://doi.org/10.1046/j.1439-0507.1999.00470.x
  5. Haran RP, Chandy MJ : Intracranial aspergillus granuloma. Br J Neurosurg 7 : 383-388, 1993 https://doi.org/10.3109/02688699309103492
  6. Herbrecht R, Denning DW, Patterson TF, Bennett JE, Greene RE, Oestmann JW, et al. : Voriconazole versus amphotericin B for primary therapy of invasive aspergillosis. N Engl J Med 347 : 408-415, 2002 https://doi.org/10.1056/NEJMoa020191
  7. Hiraga A, Uzawa A, Shibuya M, Numata T, Sunami S, Kamitsukasa I : Neuroaspergillosis in an immunocompetent patient successfully treated with voriconazole and a corticosteroid. Intern Med 48 : 1225-1229, 2009 https://doi.org/10.2169/internalmedicine.48.2165
  8. Iplikcioglu AC, Bek S, Bikmaz K, Ceylan D, Gökduman CA : Aspergillus pituitary abscess. Acta Neurochir (Wien) 146 : 521-524, 2004 https://doi.org/10.1007/s00701-004-0256-x
  9. Jain KC, Varma A, Mahapatra AK : Pituitary abscess : a series of six cas-es. Br J Neurosurg 11 : 139-143, 1997 https://doi.org/10.1080/02688699746492
  10. Koshy R, Malhotra P : Treatment of primary aspergilloma of the central nervous system in a diabetic immunocompetent patient with surgical resection and voriconazole : a case report and review of the literature. Turk Neurosurg 21 : 641-644, 2011
  11. Okugawa S, Ota Y, Tatsuno K, Tsukada K, Kishino S, Koike K : A case of invasive central nervous system aspergillosis treated with micafungin with monitoring of micafungin concentrations in the cerebrospinal fluid. Scand J Infect Dis 39 : 344-346, 2007 https://doi.org/10.1080/00365540600951333
  12. Palanisamy A, Chao SD, Fouts M, Kerr D : Central nervous system aspergillosis in an immunocompetent patient : cure in a hospice setting with very high-dose itraconazole. Am J Hosp Palliat Care 22 : 139-144, 2005 https://doi.org/10.1177/104990910502200212
  13. Petrick M, Honegger J, Daschner F, Feuerhake F, Zentner J : Fungal granuloma of the sphenoid sinus and clivus in a patient presenting with cranial nerve III paresis : case report rand review of the literature. Neurosurgery 52 : 955-958; discussion 958-959, 2003 https://doi.org/10.1227/01.NEU.0000053026.02658.4B
  14. Pinzer T, Reiss M, Bourquain H, Krishnan KG, Schackert G : Primary aspergillosis of the sphenoid sinus with pituitary invasion - a rare differential diagnosis of sellar lesions. Acta Neurochir (Wien) 148 : 1085- 1090; discussion 1090, 2006 https://doi.org/10.1007/s00701-006-0811-8
  15. Stevens DA, Kan VL, Judson MA, Morrison VA, Dummer S, Denning DW, et al. : Practice guidelines for diseases caused by Aspergillus. Infectious Diseases Society of America. Clin Infect Dis 30 : 696-709, 2000 https://doi.org/10.1086/313756
  16. Ueno A, Hamano T, Fujii A, Matsunaga A, Naganuma S, Yoneda M, et al. : [Effects of voriconazole and vascular lesions in invasion of aspergillosis into the central nerve system]. Rinsho Shinkeigaku 49 : 468-473, 2009 https://doi.org/10.5692/clinicalneurol.49.468
  17. Vates GE, Berger MS, Wilson CB : Diagnosis and management of pituitary abscess : a review of twenty-four cases. J Neurosurg 95 : 233-241, 2001 https://doi.org/10.3171/jns.2001.95.2.0233
  18. Walsh TJ, Pappas P, Winston DJ, Lazarus HM, Petersen F, Raffalli J, et al. : Voriconazole compared with liposomal amphotericin B for empirical antifungal therapy in patients with neutropenia and persistent fever. N Engl J Med 346 : 225-234, 2002 https://doi.org/10.1056/NEJM200201243460403
  19. Xiao A, Jiang S, Liu Y, Deng K, You C : Invasive intracranial aspergillosis spread by the pterygopalatine fossa in an immunocompetent patient. Braz J Infect Dis 16 : 192-195, 2012

Cited by

  1. Brain abscess: Current management vol.4, pp.suppl1, 2012, https://doi.org/10.4103/0976-3147.116472
  2. A Case of Invasive Fungal Otitis Media Progressed to Brain Abscess vol.57, pp.7, 2014, https://doi.org/10.3342/kjorl-hns.2014.57.7.484
  3. Aspergilosis cervical con diseminación al sistema nervioso central. Presentación de un caso y revisión de bibliografía vol.6, pp.21, 2012, https://doi.org/10.4103/2152-7806.167203
  4. A Case of Aspergillus Clival Abscess Treated by Endoscopic Removal vol.58, pp.1, 2012, https://doi.org/10.3342/kjorl-hns.2015.58.1.52
  5. Tumoral presentation of invasive cerebral aspergillosis vol.48, pp.1, 2012, https://doi.org/10.1590/0037-8682-0192-2014
  6. A Case of the Third, Fourth, and Sixth Nerve Palsy in a Patient with Cerebral Aspergillosis vol.56, pp.3, 2015, https://doi.org/10.3341/jkos.2015.56.3.471
  7. Aspergillus meningoencephalitis in a patient with human immunodeficiency virus infection: Normal cerebrospinal fluid does not mean absence of meningitis vol.37, pp.2, 2012, https://doi.org/10.4103/2589-0557.188482
  8. Clinical Characteristic of 12 Misdiagnosed Cases With Rare Intracranial Infection vol.26, pp.2, 2012, https://doi.org/10.1097/wnq.0000000000000150
  9. Management of granulomatous cerebral aspergillosis in immunocompetent adult patients: a review vol.30, pp.3, 2012, https://doi.org/10.3109/02688697.2016.1139046
  10. Aspergilloma Mimicking Olfactory Groove Meningioma vol.13, pp.2, 2018, https://doi.org/10.4103/1793-5482.228571
  11. Invasive sphenoid sinus aspergillosis mimicking sellar tumor: a report of 4 cases and systematic literature review vol.6, pp.None, 2020, https://doi.org/10.1186/s41016-020-00187-0
  12. Impact of Surgical and Medical Treatment on Survival of Patients with Cerebral Aspergillosis: Systematic Review of the Literature vol.149, pp.None, 2012, https://doi.org/10.1016/j.wneu.2021.01.033