Surgical Treatment Alone of Cerebral Aspergillosis in Immunocompetent Patient

Abstract

Aspergillosis is a disease that predominantly affects immunocompromised patients. The incidence in immunocompetents is rare, and manifestation is generally pulmonary. Few reports in the literature refer to isolated cerebral aspergillosis in individuals with no chronic comorbidities. We describe a case of a 59-year-old rural worker without previous pathologies who had a partial convulsive crisis in a subtle form, with self-limiting and nonrecurrent secondary generalization. Diagnostic investigation demonstrated a subcortical tumorlike lesion in the right precentral gyrus by nuclear magnetic resonance that allowed en bloc microsurgical resection, with histopathologic findings indicating cerebral aspergillosis. Because of the delay in obtaining the result of the biopsy due to technical difficulties with analysis, the diagnosis was delayed. The patient was clinically stable, with imaging without modifications and with negative serologic tests, so it was decided to follow the patient without antifungal therapy, which was successful. This was a case of isolated cerebral aspergillosis in an immunocompetent individual who was successfully treated by complete resection of the lesion alone, without combined antifungal therapy.

Cerebral Aspergillosis in an Immunocompetent Patient after COVID-19 Infection

“…3 The treatment commonly employed involves a combined approach of surgical evacuation and prolonged antifungal administration. 4,[12][13][14] There is no consensus regarding the best surgical strategy, since most studies 2,4,6,7 are small retrospective series. However, the most adopted approach in cases of location in an eloquent area is minimally-invasive aspiration by the stereotaxic method or by neuronavigation.…”