Isolated Intraventricular Aspergillosis in a Schizophrenic Patient

Abstract

Intracranial aspergillosis of the lateral ventricle is a rare condition and has not been reported in a schizophrenic patient. We report a 39-year-old male patient with underlying schizophrenia and a rapid deterioration of consciousness. Initial cranial computed tomographic images revealed focal dilatation of the posterior part of the right lateral ventricle with a severe mass effect and midline shift. The patient received an emergency endoscopic ventriculostomy, and the resected mass was proven to be aspergillus. The patient was postoperatively treated by prolonged external ventricular drainage and antifungal medication, with no recurrence of aspergillosis at the 12-month follow-up.

Intraventricular CNS aspergillosis in a patient with prior history of COVID-19: Case report and review of literature

“…For improved patient outcomes, additional treatment options such as intraventricular administration of amphotericin B have been described [ 11 ]. Despite the fact that, like other studies [ 2 , 4 ], we attributed our patient's survival to early surgical excision and the administration of antifungal agents. We also believe that COVID-19 infection causes less immunosuppression or immune dysfunction than that seen in transplant patients or patients with hematologic malignancies who require immunosuppressive medications for a longer period of time to remain in remission.…”

“…The rupture of an aspergillus brain abscess affected the intraventricular space indirectly in one case [ 1 ]. Despite the fact that hydrocephalus was observed in 5 of the cases [ 2 , 3 , 7 , 9 , 10 ], our patient did not have it. In all cases, histological examination and culture were used to make the diagnosis.…”

“…Notably, CNS aspergillosis has also been reported in immunocompetent patients [ 3 ]. Although several cases of CNS aspergillosis have been reported in the literature [ 4 , 11 ], only six cases have been linked to intraventricular aspergillosis (IVA) [ [1] , [2] , [3] , 7 , 9 , 10 ] ( Table 1 ) and none to COVID-19 infection. This is the first reported case of a COVID-19 patient being referred for IVA, with subsequent investigation indicating IPA.…”

“…In 1975, Correa et al described the first IVA, in which a lesion in the fourth ventricle blocked the foramina of Magendie, resulting in hydrocephalus [ 3 ]. Underlying conditions such as renal transplantation [ 7 , 10 ], heroin abuse [ 9 ], schizophrenia [ 2 ] and acute lymphoblastic leukemia (ALL) [ 1 ] has been reported. In this case, the underlying condition was COVID-19 infection (with corticosteroid medication).…”

“…In agreement with one author [ 13 ], we believe COVID-19 infection resulted in an immunocompromised state, which led to secondary infections of IPA and IVA. In four of the cases [ 1 , 2 , 7 , 10 ], the isolated IVA lesion was found in the lateral ventricle. The rupture of an aspergillus brain abscess affected the intraventricular space indirectly in one case [ 1 ].…”