An unexpected intracerebral lesion – case report of a superinfected aspergillosis mimicking a brain metastasis

BMC Infectious Diseases

Anna Maria Reuss¹  Elisabeth Jane Rushing¹  Athina Pangalu²  Basil Erwin Grüter³  Markus Florian Oertel³ 

[1] Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland;Department of Neuropathology, University Hospital Zurich, University of Zurich, Zurich, Switzerland;Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland;Department of Neuroradiology, University Hospital Zurich, University of Zurich, Zurich, Switzerland;Department of Neurosurgery, University Hospital Zurich, University of Zurich, Frauenklinikstrasse 10, 8091, Zurich, Switzerland;Clinical Neuroscience Center, University Hospital Zurich, University of Zurich, Zurich, Switzerland;

关键词: Aspergillosis;    Bacterial infections and mycoses;    Brain abscess;    Metastasis;    Neuroaspergillosis;   

DOI  :  10.1186/s12879-021-06176-7

来源: Springer

【 摘 要 】

BackgroundInvasive aspergillosis of the central nervous system is a rare but increasingly prevalent disease. We present the unusual case of an immunosuppressed patient suffering from unexpected superinfected invasive aspergillosis with cerebral, pulmonal, and adrenal manifestations, mimicking a metastasized bronchial carcinoma. This report reveals the importance of including aspergillosis in the differential diagnosis of a cerebral mass lesion in the light of unspecific clinical findings.Case presentationA 58-year-old immunocompromised female presented to our emergency department with a single tonic-clonic seizure. Imaging showed a ring enhancing cerebral mass with perifocal edema and evidence of two smaller additional hemorrhagic cerebral lesions. In the setting of a mass lesion in the lung, and additional nodular lesions in the left adrenal gland the diagnosis of a metastasized bronchus carcinoma was suspected and the cerebral mass resected. However, histology did not reveal any evidence for a neoplastic lesion but septate hyphae consistent with aspergillus instead and microbiological cultures confirmed concomitant staphylococcal infection.ConclusionsA high index of suspicion for aspergillus infection should be maintained in the setting of immunosuppression. Clinical and radiological findings are often unspecific and even misleading. Definite confirmation usually relies on tissue diagnosis with histochemical stains. Surgical resection is crucial for establishing the diagnosis and guiding therapy with targeted antifungal medications.

【 授权许可】

CC BY