Multifocal brain abscess caused by Aspergillus fumigatus infection in patients with Heat Stroke: a case report

Abstract

Background: Aspergillus fumigatus is a filamentous fungus widely distributed in the environment and can cause life-threatening diseases in individuals with compromised immune barriers. To our knowledge, it has never been reported as a cause of intracranial infection in patients with heat stroke. We report a case of heat stroke patient with multifocal brain abscess caused by aspergillus fumigatus infection. Case presentation: A 48-year-old male patient was admitted to the intensive care unit due to fever and loss of consciousness. The patient was diagnosed with heat stroke because he worked in a high-temperature environment, had a hospital temperature of 42℃, had liver, kidney and heart damage, and had disseminated intravascular coagulation. Although the patient was actively rescued, the patient was still coma and fever. Head Computed tomography (CT) and magnetic resonance imaging ( MRI ) showed abnormal signal lesions in bilateral basal ganglia, right temporal lobe, left frontal lobe and left cerebellar hemisphere. Serum galactomannan increased. It was identified as Aspergillus fumigatus by next generation sequencing ( NGS ) using cerebrospinal fluid. The patient received 4 weeks of voriconazole treatment. Reexamination of head CT suggested that the range of low-density lesions in the above brain regions was reduced. Then the patient gradually woke up, could follow the instructions of exercise, and finally discharged. Conclusion: Heat stroke combined with multifocal brain abscess caused by aspergillus fumigatus infection is extremely rare. For patients who still have central nervous system symptoms and signs after conventional treatment, the possibility of intracranial infection needs to be considered.