Isolated cerebral aspergillosis in an immunocompetent woman on treatment for bacterial infected necrotizing pancreatitis

Abstract

Rationale:Cerebral aspergillosis (CA) is a rare manifestation of invasive aspergillosis. It usually affects seriously immunocompromised hosts. Pancreatic bacterial or/and fungal infection is common in patients with severe acute pancreatitis.Patient concerns:We report the first case of an immunocompetent woman with infected necrotizing pancreatitis due to multidrug resistant Acinetobacter baumannii who, in the course of treatment, developed isolated CA.Diagnoses:Magnetic resonance imaging, rather than computed tomography, revealed latent homolateral sinus disease—the possible source of the Aspergillus infection.Interventions:The pancreatic infection was controlled by open necrosectomy, and the CA was disappeared after neuronavigation-guided drainage and voriconazole antifungal therapy.Outcome:The patient was discharged without complications. Our report revealed that persistent hyperglycemia, sepsisassociated immunoparalysis, and prolonged antibiotic use could impair severe patient's immunocompetence, making them more susceptible to opportunistic cerebral Aspergillus infection; the risk may be especially high in patients with paranasal sinus diseases.Lessons:Timely neurosurgical intervention combined with voriconazole antifungal therapy can provide a favorable outcome

Angio-invasive Cerebral Aspergillosis Resulting in Hemispheric Infarct in an Immunocompetent Man

“…Without proper treatment, patients of cerebral aspergillosis have poor prognosis. The mortality rate in immunocompetent patients without systemic involvement is 10-20% as compared to 90-100% in immunocompromised patients 1) . The drug of choice for CA is voriconazole, whose use has led to profound improvement in the survival rates for patients 5) .…”

“…. Neurosurgical debridement along with anti-fungal therapy has provided better survival rates than pharmacologic treatment alone 1,[6][7][8] .…”

“…Cerebral aspergillosis (CA) is an opportunistic fungal infection that usually affects immunocompromised hosts. Rarely, it has been reported to occur in immunocompetent individuals 1,2) . Due to the angio-invasive nature of Aspergillus, it has been shown to cause various vascular complications, particularly mycotic aneurysms and infarcts 3) .…”

Cerebral Aspergillosis in an Immunocompetent Patient: A Case Report

“…In this patient the lesion was adjacent to the paranasal sinuses. Administration of broad-spectrum antibiotics over a 3-month period has been shown to predispose to central nervous system aspergillosis 10 .…”