Association between a Primitive Brain Tumor and Cerebral Aspergillosis

Siegfried Hélage,Jean-Jacques Hauw,Charles Duyckaerts,Jacques Chiras,Danielle Seilhean

doi:10.1155/2012/748202

Abstract

Cerebral aspergillosis is a rare pathology of poor prognosis in spite of the use of adapted antifungal treatments. This infection of the central nervous system is generally the complication of an invasive aspergillosis with hematogenic scattering from pulmonary focal spots. It can arise in immunocompetent patients treated with prolonged corticotherapy or chemoradiotherapy for cancer. A case of lethal cerebral aspergillosis in a patient with an infiltrative glioma treated with corticotherapy and radiotherapy is reported. Clinicopathological aspects and therapeutic approach are described.

Highlights

Infections of the central nervous system (CNS) are major complications of antineoplastic treatments, mainly because of drugs that weaken the immune system, in particular corticotherapy and chemotherapy
Occurrence of a cerebral aspergillosis in patients with an infiltrative glioma does not seem rare in view of our listed cases (Table 1)
Corticosteroids act on various stages of the immune response: they inhibit the presentation of antigens on the surface of monocytes/macrophages dependent on HLA class II histocompatibility antigens, the T-lymphocytes proliferation dependent on interleukin-1 (IL-1) and on IL-2, and the cytotoxicity (T and NK) that is dependent on interferon-gamma and on IL-2

Summary

Introduction

Infections of the central nervous system (CNS) are major complications of antineoplastic treatments, mainly because of drugs that weaken the immune system, in particular corticotherapy and chemotherapy. The cerebral location is a frequent complication. The prognosis is unfavourable, with a mortality rate of about 86% [1,2,3]. The presentation of a cerebral aspergillosis is polymorphic: meningitis, meningoencephalitis, granuloma, brain abscess, and vasculitis. It can mimic cerebral tuberculosis, pyogenic abscess, or brain tumour. Aspergillosis is an infection difficult to treat, especially in immunosuppressed patients. Occurrence of a cerebral aspergillosis in patients with an infiltrative glioma does not seem rare in view of our listed cases (Table 1). We choose to report here one of these clinicopathological histories (case A)

Case Presentation

Discussion

Findings

Conclusion