Pontocerebellar Angle Aspergillosis

Mardari, Rodica; Puppa, Alessandro Della; Rotilio, Antonello; Sgarabotto, Dino; Baracchini, Claudio; Carollo, C.; Manara, Renzo

doi:10.1097/nrl.0b013e3181e530a3

Cited by 3 publications

(2 citation statements)

References 9 publications

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“…Besides, one female patient with ALL underwent T11–L1 laminectomy and ultrasound-guided aspiration for her intramedullary and extra medullary abscesses [ 28 ]. The main surgical finding was a vascularized thick capsule (soft capsule) containing a necrotic purulent component, pinkish white pus or viscous fluid [ 25 , 41 , 42 ]. In one patient, after five weeks of DAMB use, the patient’s symptoms worsened; therefore, resection of the inferior temporal lobe abscesses and debridement of the external canal, petrous apex, and mastoid air cells were performed, which led to control of the infection and recovery of the patient [ 5 ].…”

Section: Resultsmentioning

confidence: 99%

“…Given that the clinical signs of CNS aspergillosis are usually nonspecific and similar to other diseases, differential diagnosis such as lung cancer, cerebral infection or abscesses such as listeriosis, cryptococcal and tuberculous meningitis, metastatic disease and cerebral malignancy should be considered when imaging modalities are used for diagnosis in patients [ 39 ]. Noteworthy, the MRI appearance of CNS aspergillosis depends on different factors such as the timing of neuroradiologic assessment, immunologic status of the patient, and the characteristics of the fungus [ 42 ]. However, our results showed that on conventional MRI sequences in patients with leukemia, CNS aspergillosis appears as ring-enhancing lesions, with perifocal edema on MRI.…”

Section: Discussionmentioning

confidence: 99%

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Aspergillosis of central nervous system in patients with leukemia and stem cell transplantation: a systematic review of case reports

Shariati

Didehdar

Rajaeih

et al. 2021

Ann Clin Microbiol Antimicrob

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Background Aspergillosis of Central Nervous System (CNS) is a highly lethal infection in patients with leukemia and Stem Cell Transplantation (SCT). Methods Case reports of CNS aspergillosis in patients with leukemia and SCT published between 1990 and August 2020 were gathered using a structured search through PubMed/Medline. Results Sixty-seven cases were identified over the searches of the PubMed bibliographic database and then, 59 cases were included in the final analysis. Europe had the largest share of cases at 57.6% (34 reports), followed by Americas and Asia. Affected patients were predominantly males (58.6%) and the mean age of the patients was 36.1 years, while 62.7% of the patients were under the age of 50 years. The most common leukemia types include Acute Lymphoblastic Leukemia (ALL), Chronic Lymphocytic Leukemia (CLL), and Acute Myeloid Leukemia (AML) at 43.4%, 27.4%, and 23.5%, respectively. Furthermore, stem cell transplantation was reported in 11 cases. The overall mortality was 33%; however, the attributable mortality rate of CNS aspergillosis was 24.5%. Altered mental status, hemiparesis, cranial nerve palsies, and seizures were the clearest manifestations of infection and lung involvement reported in 57% of the patients. Histopathologic examination led to the diagnosis of infection in 57% of the patients followed by culture (23.7%), galactomannan assay (8.5%), and molecular method (3.3%). Amphotericin B and voriconazole were the most frequently used drugs for infection treatment. Good results were not obtained in one-third of the patients treated by voriconazole. Finally, neurosurgical intervention was used for 23 patients (39%). Conclusion CNS aspergillosis is a rapidly progressive infection in leukemic patients. Thus, these patients should be followed up more carefully. Furthermore, management of induction chemotherapy, use of different diagnostic methods, and use of appropriate antifungal can lead to infection control.

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Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Aspergillosis of central nervous system in patients with leukemia and stem cell transplantation: a systematic review of case reports

Shariati

Didehdar

Rajaeih

et al. 2021

Ann Clin Microbiol Antimicrob

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Impact of Surgical and Medical Treatment on Survival of Patients with Cerebral Aspergillosis: Systematic Review of the Literature

et al. 2021

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Central Nervous System Aspergillosis

Kourkoumpetis¹,

Desalermos²,

Muhammed³

et al. 2012

Medicine

113

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Central nervous system (CNS) aspergillosis is a highly fatal infection. We review the clinical presentation, diagnosis, and outcome of this infection and present a case series of 14 consecutive patients with CNS aspergillosis admitted to Massachusetts General Hospital (MGH) from 2000 to 2011. We also review 123 cases reported in the literature during that time. We included only proven CNS aspergillosis cases conforming to the European Organization for Research and Treatment of Cancer/Mycoses Study Group (EORTC/MSG) definitions of invasive fungal infections. In the MGH case series, neutropenia, hematologic malignancies, autoimmune diseases requiring steroid treatment, and solid organ transplantation were the predominant comorbid conditions. Notably, all MGH patients were immunosuppressed, and more than half (n = 8) had a history of previous brain injury, unrelated to their index hospitalization. For most MGH patients (11 of 14), the lung was the primary focus of aspergillosis, while 2 had paranasal sinus involvement, and 1 had primary Aspergillus discitis. Among reported cases, paranasal sinuses (27.6%) and the lung (26.8%) were the primary foci of infection, whereas 22% of those cases had no obvious primary organ involvement. Although a selection bias should be considered, especially among published cases, our findings suggest that patients who underwent neurosurgery had improved survival, with MGH and literature patients having 25% and 28.6% mortality, respectively, compared to 100% and 60.4%, respectively, among patients who received only medical treatment. Although this was not the case among MGH patients, CNS aspergillosis can affect patients without significant immune suppression, as indicated by the high number of reported immunocompetent cases. In conclusion, mortality among CNS aspergillosis patients remains high, and the infection may be more common among patients with previous brain pathology. When indicated, neurosurgical procedures may improve prognosis.

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Pontocerebellar Angle Aspergillosis

Abstract: In immunocompromised patients, the coexistence of an infectious lesion with involvement of contiguous vessels and consequent ischemic infarction should raise the suspicion of aspergillosis, even in unusual locations such as the pontocerebellar angle.

Cited by 3 publications

References 9 publications

Aspergillosis of central nervous system in patients with leukemia and stem cell transplantation: a systematic review of case reports

Aspergillosis of central nervous system in patients with leukemia and stem cell transplantation: a systematic review of case reports

Impact of Surgical and Medical Treatment on Survival of Patients with Cerebral Aspergillosis: Systematic Review of the Literature

Central Nervous System Aspergillosis

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