Invasive fungal granuloma of the brain caused by Aspergillus fumigatus: a case report and review of the literature

Turğut, Mehmet; Özsunar, Yelda; Öncü, Serkan; Akyüz, Orhan; Ertuğrul, Mustafa Bülent; Tekin, Cengiz; Gültekin, Berna; Sakarya, Serhan

doi:10.1016/j.surneu.2006.12.049

Cited by 29 publications

(27 citation statements)

References 7 publications

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“…There are only five reports in the literature of the aspergillosis in the CNS after craniotomy or tumorectomy in the last two decades [2,4-7]. …”

Section: Discussionmentioning

confidence: 99%

“…The most likely reason for the low effectiveness is the poor CNS penetration of antifungal drugs [8], which leaves neurosurgical intervention combined with antifungal therapy as the only acceptable option for treating CNS aspergillosis [4,5,8]. Turgut had discussed a more effective therapy for invasive fungal granuloma due to Aspergillus fumigatus in an immunosuppressed patient [7]. A decompressive craniotomy and five procedures at the intracranial infection site in conjunction with voriconazole and itraconazole therapy were performed on our patient with immunocompetent status to produce a temporary remission.…”

Section: Discussionmentioning

confidence: 99%

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A single aspergillus fumigatus intracranial abscess in an immunocompetent patient with parietal lobe tumorectomy

Bao

You

et al. 2014

World J Surg Onc

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Aspergillosis of the central nervous system is a rare fungal infection that is mainly reported in patients with immune deficiency, such as AIDS patients and organ transplant patients treated with immunosuppressive agents, and is uncommon among patients with intact immune function. We report here a rare case of intracranial aspergillosis in a patient who had previously undergone a parietal lobe tumorectomy. Aspergillus fumigatus was confirmed by histopathology, and susceptibility tests reported that this infection should respond to voriconazole. We believe the immunosuppression resulting from surgical trauma and glucocorticosteroid treatment may be contributing to the infection, and therefore management of these two factors may improve the prognosis.

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“…There are only five reports in the literature of the aspergillosis in the CNS after craniotomy or tumorectomy in the last two decades [2,4-7]. …”

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

A single aspergillus fumigatus intracranial abscess in an immunocompetent patient with parietal lobe tumorectomy

Bao

You

et al. 2014

World J Surg Onc

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“…We have found the current MRS findings in this case are similar to those in patients with intracranial Aspergillus, Mucormycosis, and Candida. [71719] There was a mildly decreased NAA to creatine ratio (1.10 compared with 1.81 on the contralateral side) and mildly elevated choline to creatine ratio (0.90 compared with 0.85). The choline to NAA and choline to creatine ratios were normal at 0.82 and 0.9, respectively.…”

Section: Discussionmentioning

confidence: 99%

Magnetic resonance spectroscopy imaging characteristics of cerebral Blastomycosis

Vachhani¹,

Lee²,

DeSanto

et al. 2014

Surg Neurol Int

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Background:Blastomycosis is a dimorphic fungus that is endemic to the midwest and southwestern United States. Involvement of the central nervous system (CNS) is thought to only represent 5-10% of cases of disseminated Blastomycosis.Case Description:A 54-year-old Caucasian female presented to the Neurosurgery service with a 1-day history of progressive right sided hemiparesis. Magnetic resonance imaging (MRI) demonstrated a 2 × 4 cm heterogeneous intracranial mass lesion involving the left motor cortex and extending into the ipsilateral parietal lobe. Single-voxel magnetic resonance spectroscopy (MRS) over the enhancing area demonstrated diminished N-acetyl aspartate (NAA) to creatine ratio (1.10), normal choline to NAA ratio (0.82), normal choline to creatine ratio (0.9), and a diminished myoinositol to creatine ratio (0.39). There appeared to be peaks between 3.6 and 3.8 ppm over the enhancing area that were not present in the contralateral normal brain and thought to represent a “trehalose” peak. Due to worsening symptoms and uncertain preoperative diagnosis, the patient underwent a left fronto-parietal craniotomy for open surgical biopsy with possible resection approximately one month after presentation. Pathological analysis confirmed the diagnosis of Blastomycosis.Conclusion:We present the second documented case of intracranial Blastomycosis with MRS imaging. There appears to be a characteristic peak between 3.6 and 3.8 ppm that is thought to represent a “trehalose” peak. This peak is rather specific to fungi and can be helpful in differentiating fungal abscesses from pyogenic abscesses and malignant neoplasms.

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“…When the disease is limited to the orbit, there is a 28% mortality rate for patients receiving standard treatment with amphotericin B [5]. However, once orbital apex syndrome has manifested, the mortality rate increases to 70–80% despite standard treatment, and if the central nervous system is involved, the mortality rate increases to 80–100% [4, 5, 6, 7]. …”

Section: Discussionmentioning

confidence: 99%

Orbital Aspergillosis: Voriconazole – The New Standard Treatment

Ohlstein

Hooten

Pérez

et al. 2012

Case Rep Ophthalmol

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Background/Aim: To describe a case of invasive orbital aspergillosis and evaluate treatments and outcomes. Methods: A case report and review of orbital aspergillosis treatment with voriconazole in the English language literature. Conclusion: Amphotericin B with debridement is the current standard of care for orbital aspergillosis; however, its prognosis is unfavorable. When compared to amphotericin B, voriconazole demonstrates a survival benefit, has less systemic toxicity, and is better tolerated by patients. While a prospective trial comparing amphotericin B to voriconazole in orbital aspergillosis is not feasible, there is evidence to support the use of voriconazole as primary therapy.

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Invasive fungal granuloma of the brain caused by Aspergillus fumigatus: a case report and review of the literature

Cited by 29 publications

References 7 publications

A single aspergillus fumigatus intracranial abscess in an immunocompetent patient with parietal lobe tumorectomy

A single aspergillus fumigatus intracranial abscess in an immunocompetent patient with parietal lobe tumorectomy

Magnetic resonance spectroscopy imaging characteristics of cerebral Blastomycosis

Orbital Aspergillosis: Voriconazole – The New Standard Treatment

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