Isolated cerebral aspergillus abscess as a complication of pulmonary alveolar proteinosis in a child

Khera, Rachna; Rao, Venkateswara; Pasam, Mohan Krishna; Tagore, Ravindranath; Murthy, Sudha S; Challa, Sundaram

doi:10.1186/s41016-019-0165-8

Cited by 3 publications

(1 citation statement)

References 15 publications

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“…The patient was treated with voriconazole with uneventful follow-up till date. 6 De Villiers De La Noue V et al reported a 20 mm left parietal corticosubcortical cerebral abscess associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Stereotaxic brain biopsy revealed the presence of Aspergillus fumigatus.…”

Section: Discussionmentioning

confidence: 99%

A Rare Case of COVID-19-Associated Solitary Aspergillus Brain Abscess

Parambil,

Thavara,

Francis

et al. 2023

Asian J Neurosurg

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Surgically operated case of solitary Aspergillus brain abscess caused by Aspergillus fumigatus in coronavirus disease 2019 (COVID-19) patient is not reported. The authors report a case of 33-year-old diabetic female patient presented with generalized seizure followed by left hemiparesis. Patient was treated with steroids for COVID-19 pneumonia. Initial imaging revealed a right frontal lobe infarct that later confirmed as a case of frontal lobe abscess. Patient underwent craniotomy and thick yellow pus was drained. Abscess wall was excised. Postoperatively patient improved with Glasgow coma scale 15/15 and Medical Research Committee grade 5 power of all limbs. Microbiological examination of pus was done. The gram stain showed numerous pus cells with acute angle branching hyphae. Gomori methenamine silver (GMS) preparation showed filamentous black colored hyphae. Mycelial colonies appeared on chocolate agar after 48 hours of incubation. Cellophane tape mount from the plate showed conical shaped vesicle with conidia arising from the upper third of vesicle. Light green velvety colonies appeared on Sabouraud Dextrose Agar that later turned into smoky green. The isolate was identified as Aspergillus fumigatus. The hematoxylin and eosin stain of abscess wall section showed extensive areas of necrosis with few fungal hyphae. GMS stain of abscess wall showed fungal hyphae that are septate and showing acute angled branching which are consistent with Aspergillus species. Patient was treated with voriconazole. Imaging done after 8 months of surgery revealed no residue. Surgical excision of life-threatening solitary Aspergillus brain abscess along with antifungal medication voriconazole carries good result. The authors believe that decreased immunity in patient has contributed to the development of this rare disease. This is a rarest case of surgically operated solitary brain abscess caused by Aspergillus fumigatus in COVID-19 patient.

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Section: Discussionmentioning

confidence: 99%

A Rare Case of COVID-19-Associated Solitary Aspergillus Brain Abscess

Parambil,

Thavara,

Francis

et al. 2023

Asian J Neurosurg

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Opportunistic Infection Associated With Elevated GM-CSF Autoantibodies: A Case Series and Review of the Literature

Lee

Miller

Ataya

et al. 2022

Open Forum Infectious Diseases

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Granulocyte-macrophage colony-stimulating factor (GM-CSF) is known to play a key role in enhancing multiple immune functions that affect response to infectious pathogens including antigen presentation, complement- and antibody-mediated phagocytosis, microbicidal activity, and neutrophil chemotaxis. Reduced GM-CSF activity and immune response provides a mechanism for increased infection risk associated with autoimmune pulmonary alveolar proteinosis (aPAP) and other disorders involving the presence of GM-CSF autoantibodies. We present a case series of five patients with persistent or unusual pulmonary and central nervous system opportunistic infections (Cryptococcus gattii, Flavobacterium, Nocardia) and elevated GM-CSF autoantibody levels, as well as 27 cases identified on systematic review of the literature.

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Fatal Case of Cerebral Aspergillum in an Immunocompetent Patient

Sharifi

Hajiesmaeili

Darazam

et al. 2020

Arch Clin Infect Dis

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Introduction: Cerebral aspergillum is rare and usually misdiagnosed because its presentation mimics tuberculous meningitis, brain abscess, or tumor. The diagnosis and treatment of central nervous system (CNS) infections due to Aspergillus are very difficult because accurate diagnosis is often made intra-operatively. Case Presentation: Here, we report a case of cerebral aspergilloma in an immunocompetent host. A 35-year-old man admitted with progressive left hemifacial paresthesia followed by severe pain in trigeminal nerve territory. On physical examination, except for fifth nerve palsy and difficult mastication, there was not any sensory and motor deficit. Magnetic resonance imaging (MRI) of the brain showed T1 iso and T2 low signal lesion in the left parasellar region with enhancement. The lesion is extended to the left side of the prepontine cistern in the course of trigeminal nerve, craniotomy, and total surgical resection of the mass was performed. Isolated brain lesion and the pathology from stereotactic biopsy confirmed cerebral aspergillosis. The result of testing for human immunodeﬁciency virus (HIV) was negative. Although the patient had two subsequent recurrences, at first, good outcome was achieved by treatment with a combination of surgical intervention, and antifungal amphotericin B deoxycholate was administered, then changed to voriconazole. Unfortunately, after two years, he experienced new progressive symptoms, and the patient died despite several reoperations due to malfunctioning of external ventricle devices as well as the treatment of recurrent post-operation meningitis and voriconazole therapy. Conclusions: Most cases of intracranial aspergillosis show that this infection is pathogenic in immunocompromised hosts; however, in some cases, invasive Aspergillus was reported as an opportunistic infection in immunocompetent patients. In these patients, though primary cranial aspergillosis is very rare, it is possible that isolated brain involvement in a previously healthy case may be explained by unknown defects in immune pathways or massive exposure to spores.

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Isolated cerebral aspergillus abscess as a complication of pulmonary alveolar proteinosis in a child

Cited by 3 publications

References 15 publications

A Rare Case of COVID-19-Associated Solitary Aspergillus Brain Abscess

A Rare Case of COVID-19-Associated Solitary Aspergillus Brain Abscess

Opportunistic Infection Associated With Elevated GM-CSF Autoantibodies: A Case Series and Review of the Literature

Fatal Case of Cerebral Aspergillum in an Immunocompetent Patient

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