Aspergillus sinusitis complicated with meningitis and multiple cerebral infarctions in immunocompetent patient

Abstract

33 ‫العمر‬ ‫من‬ ‫يبلغ‬ ‫ذكر‬ ‫مريض‬ ‫حالة‬ ‫التقرير‬ ‫هذا‬ ‫في‬ ‫نستعرض‬ ‫الضوء،‬ ‫وخوف‬ ‫الرقبة،‬ ‫في‬ ‫وآالالم‬ ‫حاد،‬ ‫صداع‬ ‫من‬ ‫يعاني‬ ‫عام‬ ‫أن‬ ‫بالذكر‬ ‫اجلدير‬ ‫أيام.‬ ‫لعدة‬ ‫احلرارة‬ ‫درجة‬ ‫في‬ ‫وارتفاع‬ ‫واستفراغ،‬ ‫للجيوب‬ ‫مزمن‬ ‫التهاب‬ ‫مع‬ ‫أنفية‬ ‫لسليلة‬ ‫إزالة‬ ‫بعملية‬ ‫قام‬ ‫املريض‬ ‫للمريض‬ ‫السريري‬ ‫الفحص‬ ‫خالل‬ ‫املاضية.‬ ‫السنوات‬ ‫الثمان‬ ‫األنفية‬ ‫طبيعية‬ ‫قوى‬ ‫مع‬ 15/15 ‫جالسكو‬ ‫مقياس‬ ‫على‬ ‫الوعي‬ ‫مستوى‬ ‫كان‬ ‫املالحظة‬ ‫من‬ ‫ملزيد‬ ‫إيجابية.‬ ‫بابينسكي‬ ‫عالمة‬ ‫وكانت‬ ‫باألطراف‬ ‫الفحوصات‬ ‫جميع‬ ‫وعمل‬ ‫املستشفى‬ ‫في‬ ‫تنوميه‬ ‫مت‬ ‫أكثر،‬ ‫بشكل‬ ‫احليوية‬ ‫املضادات‬ ‫إعطاء‬ ‫في‬ ‫البدء‬ ‫من‬ ‫الرغم‬ ‫على‬ ‫الالزمة.‬ ‫وإمنا‬ ‫حالته‬ ‫في‬ ‫مباشر‬ ‫حتسن‬ ‫أي‬ ‫يظهر‬ ‫لم‬ ‫املريض‬ ‫أن‬ ‫إال‬ ‫االختبارية‬ ‫في‬ ‫واستسقاء‬ ‫بصري،‬ ‫عجز‬ ‫بسبب:‬ ‫مثير‬ ‫بشكل‬ ‫حالته‬ ‫تدهورت‬ ‫متعددة‬ ‫دماغية‬ ‫واحتشاءات‬ ‫الوعي،‬ ‫مستوى‬ ‫في‬ ‫تدني‬ ‫مع‬ ‫الدماغ‬ ‫عملية‬ ‫عمل‬ ‫مت‬ ‫اللحظة،‬ ‫تلك‬ ‫بعد‬ ‫الدماغ.‬ ‫أنحاء‬ ‫مختلف‬ ‫في‬ ‫إعطاء‬ ‫في‬ ‫االستمرار‬ ‫مع‬ ‫الدماغ‬ ‫عن‬ ‫الضغط‬ ‫إلزالة‬ ‫القحف‬ ‫قطع‬ ‫مستوى‬ ‫تدنى‬ ‫ذلك‬ ‫مع‬ ‫الفطريات.‬ ‫ومضادات‬ ‫احليوية‬ ‫املضادات‬ ‫اإلنعاش‬ ‫ينجح‬ ‫ولم‬ ‫جالسكو،‬ ‫مقياس‬ ‫على‬ 3/15 ‫إلى‬ ‫الوعي‬ ‫اجلدير‬ ‫من‬ ‫التالي.‬ ‫اليوم‬ ‫في‬ ‫وتوفى‬ ‫املريض‬ ‫احياء‬ ‫في‬ ‫الرئوي‬ ‫القلبي‬ ‫خطيرة،‬ ‫مضاعفات‬ ‫إلى‬ ‫يؤدي‬ ‫أن‬ ‫ميكن‬ ‫الرشاشيات‬ ‫داء‬ ‫أن‬ ‫لالنتباه‬ ‫والعالج.‬ ‫التشخيص‬ ‫في‬ ‫التأخر‬ ‫عدم‬ ‫من‬ ‫البد‬ ‫لذا‬ This is a case of a 33-year-old male complaining of severe headache, neck pain, photophobia, vomiting and high-grade fever of several days. He had history of nasal polyp removal and recurrent sinusitis in the last 8 years. On examination: conscious with glasco coma scale (GCS) 15/15 and normal limbs strength butwith positive Babinski sign. For further observation, he was admitted and full work-up was done. Even though full empirical antibiotics were started, there was no immediate improvement and he deteriorated dramatically developing ocular deficit, hydrocephalus and lower level of consciousness with multiple infarctions found at different areas in brain. After that point, a decompressive craniectomy was done, and multiple antibiotics and antifungal medications were prescribed. However, he deteriorated to GCS 3/15; cardiopulmonary resuscitations were not successful, as he demised next day. It shall be noted that aspergillosis can lead to difficult complications, so diagnosis and treatments should not be delayed.

Aspergillus sinusitis complicated with meningitis and multiple cerebral infarctions in immunocompetent patient

“…Cytology report was negative for malignant cells". 1 I presume that such histopathologic findings didn't totally exclude CGD as there was no clear-cut notice of the absent of granuloma in the histopathologic report. I presume that the following 2 laboratory tools were solicited to be employed to favor diagnosis of CGD in the studied Correspondence patient.…”

“…1 I presume that the authors considered their studied patient immunocompetent based on their obvious notion that "multiple investigations were carried out including lumbar puncture, Human immunodeficiency virus(HIV) screening, Perinuclear anti-neutrophil cytoplasmic antibody (P-ANCA), Cytoplasmic antineutrophil cytoplasmic antibodies (C-ANCA) and antinuclear antibody (ANA) were all negative". 1 Despite that explanation, I still presume that jeopardized immune status had greatly contributed to the drastic escalation in the clinical presentation and, importantly, chronic granulomatous disease (CGD) ought to be seriously considered in the studied patient. My presumption is based on the following point: It is explicit that CGD is caused by defects in the genes encoding any of the nicotinamide adenine dinucleotide phosphate (NADPH) oxidase components responsible for the respiratory burst of phagocytic leukocytes.…”

“…I presume that the following 2 laboratory tools were solicited to be employed to favor diagnosis of CGD in the studied Correspondence patient. 1 Mutation analysis of genes encoding various NADPH oxidase components. 2 Flow cytometric dihydrorhodamine neutrophil respiratory burst assay to evaluate NADPH oxidase function.…”

Progression of chronic rhinosinusitis to invasive cerebro-orbital aspergillosis following steroid treatment: A case of induced immunosuppression

“…However, it may sometimes develop into invasive infection, commonly in immunocompromised individuals [3] , [4] . Recently, there has been a substantial increase in the number of reported acute invasive fungal infections in immunocompetent individuals [3] , [5] , [6] , [7] , [8] , [9] , [10] , [11] . We present a case of an immunocompetent young adult initially presenting with CRSwNP who then developed invasive aspergillosis with cerebral and orbital involvement.…”