Cerebral aspergillosis in a patient with leprosy and diabetes: a case report

Segundo, João Batista Alves; Silva, Marcos Antônio Custódio Neto da; Filho, Walbert Edson Muniz; Nascimento, Maria do Desterro Soares Brandão; Vidal, Flávia Castello Branco; Viana, Graça Maria de Castro; Nascimento, Maria do Desterro Soares Brandão

doi:10.1186/1756-0500-7-689

Cited by 10 publications

(4 citation statements)

References 29 publications

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“…[ 6 – 9 ] Diabetic patients are more susceptible to Aspergillus infection. [ 10 ] Among 34 cases of CNS aspergillosis analyzed in the current study, 23.5% were caused by sinusitis, and 16.6% had concomitant diabetes; other causes included gingivitis, mastoiditis, and meningioma surgery.…”

Section: Discussionmentioning

confidence: 88%

Central nervous system aspergillosis in immunocompetent patients

et al. 2020

Medicine

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The aim of this study was to investigate the clinical characteristics of central nervous system (CNS) aspergillosis in immunocompetent patients. This study enrolled six immunocompetent patients diagnosed with CNS aspergillosis. Additionally, we reviewed the clinical profiles for 28 cases reported in the literature. The age, gender, etiology of Aspergillus infection, clinical manifestations, location of the lesion, treatment, and prognosis were analyzed. There were 19 men (average age, 54.6 ± 14.3 years) and 15 women (average age, 47.0 ± 19.4 years). The clinical manifestations included headache (55.9%; n = 19), visual impairment (32.4%; n = 11), diplopia (32.4%; n = 11), hemiplegia (20.6%; n = 7), fever (17.6%; n = 6), and epilepsy (8.8%; n = 3). According to the radiological features, CNS aspergillosis lesions were divided into two subtypes: parenchymal lesions in the cerebral lobes (n = 11), and meningeal lesions in the meninges (n = 23). The patients with meningeal lesions are easy to be complicated with more serious cerebrovascular diseases, such as subarachnoid hemorrhage and massive infarction. Most of the lesions in brain parenchyma were abscess formation, and magnetic resonance imaging showed ring enhancement. The clinical diagnosis of Aspergillus infection was mainly based on brain biopsy (n = 14), autopsy (n = 8), pathological examination of adjacent brain tissues (n = 7), cerebrospinal fluid (CSF) or tissue culture (n = 3), and second-generation sequencing analysis of the CSF (n = 3). Clinical improvement was achieved in 23 cases, and 11 patients succumbed to the disease. Voriconazole treatment was effective in 24 (70.6%) cases. Immunocompetent subjects are also at risk for Aspergillus infections. Concomitant cerebrovascular diseases are common in patients with CNS aspergillosis, especially in patients with meningeal aspergillosis. Parenchymal aspergillosis lesions are usually localized and manifest as brain abscesses with annular enhancement on magnetic resonance imaging. Biopsy, CSF culture, and next-generation sequencing are mainstream diagnostic modalities. Voriconazole is an effective treatment for Aspergillus infection, and early diagnosis and treatment should be highlighted.

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Section: Discussionmentioning

confidence: 88%

Central nervous system aspergillosis in immunocompetent patients

et al. 2020

Medicine

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“…Diabetes mellitus has not been recognized as a risk factor for invasive aspergillosis [1]. The published literature of invasive CA in patients with diabetes mellitus is limited to clinical reports of single or multiple cases [2][3][4][5].…”

Section: Discussionmentioning

confidence: 99%

A fatal case of cerebral aspergillosis in a diabetes mellitus patient

et al. 2015

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A 64-year-old right-handed diabetic man was presented into our hospital with 1 week history of left-sided limb weakness. One month ago he had been diagnosed with diabetes mellitus and the blood glucose level was poorly controlled. He compulsively reduced his intake and experienced unintentional weight loss. Apart from his limb weakness, he complained fever and progressive headaches in the last 2 weeks. His highest temperature was 40°C. Past medical history was negative for tuberculosis, bone marrow and solid organ transplantation and malignancy. Moreover, there was no history of steroid or other immunosuppressive drug consumption.On physical examination, his general condition was poor as a result of malnutrition. The neurological examination revealed that left hemiplegia and meningeal irritation signs were positive. The serum complete blood count showed a white cell count of 10,210/mm 3 with 76.4 % neutrophils. The glucose level was 632 mg/dL. Viral markers were negative. Lumbar puncture was performed and the opening pressure was 245 cm H 2 O. Cerebrospinal fluid (CSF) contained a white cell count of 522/mm 3 (94 % neutrophils), a protein concentration of 102.2 mg/dL, and a glucose concentration of 95 mg/dL. The chest X-ray was normal. After admission, cranial computed tomography (CT) scan showed a hypointense lesion on right basal ganglia area. Diffusion magnetic resonance imaging (MRI) showed restricted diffusion in the same area.He was initially treated for an acute ischaemic stroke and administered aspirin and rosuvastatin, but his condition sharply deteriorated. Three days after presentation, the second CT scan revealed a hyperintense lesion with surrounding brain edema (Fig. 1). Two days later, he slipped into a coma. Subsequent MRI revealed an occupying lesion with high density and moderate mass in the frontal lobe, with edema in the surrounding area. The lesion showed slightly low signal intensity in T1-weighted sequences with strong enhancement.A right pterional approach craniotomy was performed for pathologic diagnosis and excision of brain abscess. The surgical specimens showed many vessels thrombosis,haemorrhage, inflammatory granulation tissue. Periodic acid-Schiff stain demonstrated a small vessel invasion by septate hyphae of aspergillosis (Fig. 2). During the postoperative period, the patient was treated with intravenous voriconazole. Unfortunately, his health condition deteriorated and he died on hospital day 27.

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“…Opportunistic fungi are ubiquitous, and the second most frequent extrapulmonary disease from Aspergillus is in the CNS 51.…”

Section: Discussionmentioning

confidence: 99%

Skull base aspergillosis in an immunocompetent elderly man with early response to steroid

Sarkar¹,

Price

Fish

et al. 2018

BMJ Case Rep

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We report the case of a previously well 80-year-old man who presented with subacute bilateral painful optic neuropathy with initial response to corticosteroids but ultimately progressed to a fatal skull base syndrome. Initial presentation of steroid-responsive painful bilateral posterior optic neuropathy, preliminary normal enhanced MRI, normal cerebrospinal fluid and inflammatory markers indicated atypical optic neuritis. However, this progressed to a bilateral orbital apex syndrome with ophthalmoplegia and evidence of abnormal skull base enhancement on subsequent MRI. Biopsy of radiologically abnormal dura was non-diagnostic and negative for fungal stains. He deteriorated and died 8 months after initial presentation. At postmortem, fungal skull base infection was diagnosed. This case demonstrates that chronic skull base fungal infection can: (1) present in elderly immunocompetent patients, (2) show initial improvement with corticosteroids and (3) evade diagnosis on biopsy. We encourage a high index of suspicion for fungal skull base infection in similar cases.

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Cerebral aspergillosis in a patient with leprosy and diabetes: a case report

Cited by 10 publications

References 29 publications

Central nervous system aspergillosis in immunocompetent patients

Central nervous system aspergillosis in immunocompetent patients

A fatal case of cerebral aspergillosis in a diabetes mellitus patient

Skull base aspergillosis in an immunocompetent elderly man with early response to steroid

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