Cerebral aspergillosis in a patient with leprosy and diabetes: a case report

BMC Research Notes

Maria do Desterro Soares Brandão Nascimento³  Graça Maria de Castro Viana⁵  Geusa Felipa de Barros Bezerra⁵  Flávia Castello Branco Vidal²  Anna Cyntia Brandão Nascimento⁴  Walbert Edson Muniz Filho⁵  Marcos Antonio Custódio Neto da Silva¹  João Batista Alves Segundo¹ 

[1] Medicine Course, Federal University of Maranhão, Gonçalves Dias Square, s/n, São Luís, Maranhão, Brazil;Department of Morphology, Federal University of Maranhão, São Luís, Maranhão, Brazil;Medicine Course, State University of Maranhão, Caxias, Maranhão, Brazil;University Hospital of Federal University of Maranhão, Street Barão of Itapary, 227, Center, São Luís, Maranhão, Brazil;Department of Pathology, Nucleum of Basic and Applied Immunology, Federal University of Maranhão, São Luís, Maranhão, Brazil

关键词: Aspergillus fumigatus;    Mycotic arteritis;    Diabetes;    Leprosy;    Cerebral aspergillosis;   

Others  :  1127376
DOI  :  10.1186/1756-0500-7-689

 received in 2014-06-18, accepted in 2014-09-22,  发布年份 2014

【 摘 要 】

Background

Opportunistic fungi are dispersed as airborne, ground and decaying matter. The second most frequent extra-pulmonary disease by Aspergillus is in the central nervous system.

Case presentation

The case subject was 55 years old, male, mulatto, and an assistant surveyor residing in Teresina, Piauí. He presented with headache, seizures, confusion, fever and left hemiparesis upon hospitalization in 2006 at Hospital São Marcos. Five years previously, he was diagnosed with diabetes mellitus, and 17 months previously he had acne margined by hyperpigmented areas and was diagnosed with leprosy. Laboratory tests indicated leukocytosis and magnetic resonance imaging showed an infarction in the right cerebral hemisphere. Cerebrospinal fluid examination showed 120 cells/mm³ and was alcohol-resistant bacilli negative. Trans-sphenoidal surgery with biopsy showed inflammation was caused by infection with Aspergillus fumigatus. We initiated use of parenteral amphotericin B, but his condition worsened. He underwent another surgery to implant a reservoir of Ommaya–Hickmann, a subcutaneous catheter. We started liposomal amphotericin B 5 mg/kg in the reservoir on alternate days. He was discharged with a prescription of tegretol and fluconazole.

Conclusion

This report has scientific interest because of the occurrence of angioinvasive cerebral aspergillosis in a diabetic patient, which is rarely reported. In conclusion, we suggest a definitive diagnosis of cerebral aspergillosis should not postpone quick effective treatment.

【 授权许可】

   
2014 Segundo et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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