Tumoral form of aspergillosis in central nervous system (cerebral aspergilloma): case report

Figueiredo, Eberval Gadelha; Fonoff, Erich Talamoni; Gomes, Marcos da Silva; Macedo, E. M. L.; Júnior, Raul Marino

doi:10.1590/s1516-31802003000600007

Cited by 15 publications

(9 citation statements)

References 4 publications

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“…As an opportunistic infection, disseminated aspergillosis usually begins with pulmonary involvement due to immunosuppression by steroids, antineoplastic agents, or with transplantation (Beal et al, 1982; Walsh et al, 1985; Barrios et al, 1988; Torre-Cisneros et al, 1993; Hori et al, 2002; Kleinschmidt-DeMasters, 2002; Saitoh et al, 2007). CNS aspergillosis has also been seen with diabetes (Torre-Cisneros et al, 1993; Nenoff et al, 2001; Figueiredo et al, 2003) or via contiguous spread from areas of nearby tissue or bone such as the paranasal sinuses (Haran and Chandy, 1993; Botturi et al, 2006; Sundaram et al, 2006). It should be noted that infection can occur in clinically immunocompetent individuals (Haran and Chandy, 1993; Sundaram et al, 2006).…”

Section: Case Presentation and Discussionmentioning

confidence: 99%

Central nervous system Aspergillus infection after epidural analgesia: diagnosis, therapeutic challenges, and literature review

Genzen

Kenney

2009

Diagnostic Microbiology and Infectious Disease

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Aspergillus terreus was identified in an intra-dural spinal biopsy specimen from an African female with recurrent headache and hydrocephalus. Prior laboratory testing of cerebrospinal fluid (CSF) was non-diagnostic, despite extensive central nervous system (CNS) involvement. CNS Aspergillus infection presents a diagnostic and therapeutic challenge and is reviewed in the context of this particularly instructive and difficult case. CASE PRESENTATION AND DISCUSSIONThe patient was a 37 year old West African female who presented to our emergency department with headache, blurry vision, and numbness in the left lower extremity. Twelve months prior to admission, while still living in Africa, she underwent a cesarean section accompanied by epidural analgesia. Her post-partum course was notable for episodes of recurrent headache. She subsequently moved to the United States where her headaches continued.The patient returned to Africa three months prior to the present admission. During that time she visited an emergency department with symptoms of severe headache, and a computed tomography (CT) scan demonstrated dilation of the lateral, third, and fourth cerebral ventricles. She returned to the United States and presented to our emergency department shortly thereafter.The patient had an admission temperature of 37.4°C. Bilateral papilledema, mild oral thrush, and brisk deep tendon reflexes in the lower extremities were noted on physical examination. Brain magnetic resonance imaging (MRI) suggested communicating hydrocephalus ( Figure 1A), although slight abnormal enhancement anterior to the pons and encasing the basilar artery was also noted (not shown).Initial complete blood count (CBC), erythrocyte sedimentation rate (ESR), and serum chemistries were in the normal range. A lumbar puncture on Day 1 (Table 1) Publisher's Disclaimer: This is a PDF file of an unedited manuscript that has been accepted for publication. As a service to our customers we are providing this early version of the manuscript. The manuscript will undergo copyediting, typesetting, and review of the resulting proof before it is published in its final citable form. Please note that during the production process errors may be discovered which could affect the content, and all legal disclaimers that apply to the journal pertain. Numerous tests for human immunodeficiency virus (HIV) and hepatitis A, B, and C were all negative. Serum angiotensin converting enzyme and calcium were both normal, and tuberculin skin testing was negative. A repeat lumbar puncture (Day 5) showed persistent hypercellularity but was read as negative for malignant cells by cytology. Cell counts, chemistries, and smears/ cultures were otherwise unchanged. NIH Public AccessUpon consultation with the neurosurgical team and consent of the patient, a ventriculoperitoneal (VP) shunt was placed on Day 7, although she declined a surgical biopsy of the area of abnormal brain MRI enhancement. Placement of the shunt was accompanied by significant symptomatic improvement. An MRI of th...

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Section: Case Presentation and Discussionmentioning

confidence: 99%

Central nervous system Aspergillus infection after epidural analgesia: diagnosis, therapeutic challenges, and literature review

Genzen

Kenney

2009

Diagnostic Microbiology and Infectious Disease

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“…14,19 Neuroimaging findings are nonspecific, and in some instances cerebral forms of aspergillosis can appear similar to tumors. 8 Nonetheless, two studies have recently demonstrated that contrast-enhanced MR imaging and CT scanning play an important role in establishing the early diagnosis of cerebral aspergillosis in high-risk, immunocompromised patients. 14,16 The findings of multiple lesions in the corticomedullary junction with centrally located enhancement on CT scanning and MR imaging studies can be helpful in distinguishing aspergillosis.…”

Section: Discussionmentioning

confidence: 99%

Improved survival in central nervous system aspergillosis: a series of immunocompromised children with leukemia undergoing stereotactic resection of aspergillomas

Middelhof¹,

Loudon²,

Muhonen³

et al. 2005

Journal of Neurosurgery: Pediatrics

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Central nervous system (CNS) aspergillosis remains a daunting diagnosis. This opportunistic mycosis historically carries a mortality rate approaching 100% in immunocompromised patients, with death ensuing within days after the onset of neurological symptoms. From their literature review, the authors concluded that children contracting CNS aspergillosis while undergoing systemic chemotherapy for leukemias represent a particularly unfortunate prognostic group. Antifungal medications prove ineffective for treating CNS aspergillosis in patients immunocompromised because of their chemotherapy regimens. In contrast, withholding chemotherapy to reverse immunosuppression, thereby improving the efficacy of antifungal medications, allows for progression of the primary leukemic disease. The authors present a series of four immunosuppressed patients whose course of treatment for leukemia was complicated by CNS Aspergillus sp. abscesses. Multiple cerebral fungal abscesses developed in two patients and a single cerebral abscess developed in two. All four patients underwent frameless stereotactic resection of the aspergilloma. All children later experienced resolution of their CNS infections and full neurological recovery. At 2- to 4-year follow ups, one patient has died of leukemia and the other three continue to thrive without evidence of recurrent aspergillosis. Given the grave natural history cited in the literature for this disease when medical treatment is instituted alone, the authors stress the crucial role of stereotactic neurosurgery for the intelligent treatment of immunocompromised children suspected of harboring a CNS aspergilloma abscesses. The authors propose that the goal for successful treatment in these patients should be gross-total resection of the abscess, its wall, and its capsule.

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“…Usually, it affects patients with a known underlying immune-compromised state like patients with haemopoietic stem cell transplant, solid organ transplant, AIDS, patients on immunosuppressive drugs, uncontrolled diabetes mellitus and those suffering with cancer 1. Cranial aspergillosis can have varied presentations that may range from meningitis, encephalitis with cerebral abscess formation, cerebrovascular disease and very rarely as intracranial masses 2 3. Owing to its angio-invasive nature, cerebrovascular event secondary to cerebral aspergillosis is an unpredictable and a fatal complication.…”

Section: Introductionmentioning

confidence: 99%

Cranial aspergilloma masquerading as meningioma

et al. 2013

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Cranial aspergillosis may present as meningitis, cerebral abscess, cerebral infarcts/haemorrhages or extra-axial mass. Extra-axial cranial aspergilloma may mimic meningioma owing to mass-like characteristics and intense contrast enhancement on MRI there by delaying the diagnosis and further worsening the already bad prognosis in these patients. We present a 45-year-old gentleman who presented with signs of raised intracranial hypertension, secondary optic atrophy and a contrast-enhancing mass arising from the planum sphenoidale. Postoperatively, mass was diagnosed as aspergilloma on histopathology and culture. Despite antifungal treatment, patient could not be saved due to large artery infarcts in the immediate postoperative period. We discuss the clinical and MRI features that could help to have sufficient and early suspicion of fungal aetiology in these patients.

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Tumoral form of aspergillosis in central nervous system (cerebral aspergilloma): case report

Cited by 15 publications

References 4 publications

Central nervous system Aspergillus infection after epidural analgesia: diagnosis, therapeutic challenges, and literature review

Central nervous system Aspergillus infection after epidural analgesia: diagnosis, therapeutic challenges, and literature review

Improved survival in central nervous system aspergillosis: a series of immunocompromised children with leukemia undergoing stereotactic resection of aspergillomas

Cranial aspergilloma masquerading as meningioma

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