Cerebral Aspergillosis in an Immunocompetent Patient after COVID-19 Infection

Abstract

Fungal brain abscesses are an uncommon condition in the immunocompetent population, especially due to the etiologic agent Aspergillus sp. The emerging coronavirus disease 2019 (COVID-19) pandemic brought about neurological manifestations that were previously little known, caused by the direct manifestations of the virus, as well as by the therapy itself, with hospitalization and use of corticosteroids. This highlights the need for attention in the management of patients with neurological disorders and history of virus infection. In the current paper, we report the case of a patient without comorbidities who presented multiple brain abscesses caused by Aspergillus fumigatus, after infection by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).

A Rare Case of Invasive Central Nervous System Aspergillus niger in a Previously Immunocompetent Patient After Corticosteroid Treatment for COVID-19

“…The extent of CNS invasion, location of intracranial spread, and clinical manifestations of Aspergillus differ through described cases in the literature, but focal neurological signs, fever, headache, vomiting, papilledema, seizures, and changes in mental status are reported symptoms at presentation [ 3 ], raising concern for meningitis, meningoencephalitis, or increased intracranial pressure [ 11 ].…”

“…Treatment for CNS infection depends on clinical presentation, medications that contraindicate treatment with amphotericin B and triazoles, and tolerance of these medications. Common treatment plans include a combination of surgical intervention and antifungal medication [ 3 , 17 ]. The most common surgical approach consists of a minimally invasive aspiration by the stereotaxic method or neuronavigation [ 3 ].…”

“…Common treatment plans include a combination of surgical intervention and antifungal medication [ 3 , 17 ]. The most common surgical approach consists of a minimally invasive aspiration by the stereotaxic method or neuronavigation [ 3 ]. Though cases in the literature report successful treatment of intracranial Aspergillus utilizing voriconazole and a corticosteroid [ 17 ], outcomes in such patients remain guarded.…”

“…Invasive central nervous system (CNS) aspergillosis is particularly rare, and data on its epidemiology, especially in immunocompetent individuals, is limited. Aspergillus is treated with antifungals, and in some invasive cases, surgical intervention is necessary [ 3 ].…”

“…Invasive central nervous system (CNS) aspergillosis is particularly rare, and data on its epidemiology, especially in immunocompetent individuals, is limited. Aspergillus is treated with antifungals, and in some invasive cases, surgical intervention is necessary [3]. This case presents a 67-year-old previously immunocompetent woman with no underlying health conditions who received corticosteroid treatment for COVID-19 prior to experiencing altered mental status (AMS) and subsequent hospital admission.…”