Cerebral Aspergillosis on autopsy; masquerading clinically as Brain tumor in a young female

Shweta Rana,Sonia Hasija,Pawan Singh,Ashok Sangwaiya,Shivani Kalhan

doi:10.7439/ijbar.v6i1.1496

Abstract

Cerebral aspergillosis is a rare pathology with fatal outcome. It is mostly a post-mortem diagnosis because the initial symptoms are mostly nonspecific and the existing diagnostic modalities are not sensitive to ensure early and definite diagnosis. The clinical manifestations and disease severity are dictated by the immunologic state of the patient. Cerebral aspergillosis can mimic tuberculous meningitis, pyogenic abscess, or brain tumor. Maxillary sinusitis of dental origin or the lungs are the most common sites of primary aspergillus infection. Infection reaches the brain directly from the nasal sinuses via vascular channels or is blood borne from the lungs and gastrointestinal tract. Dissemination of aspergillus is relatively common, with the central nervous system (CNS) being one of the most frequent sites of Invasive aspergillosis (IA) after the lungs. Aspergillosis should be considered in cases manifesting with acute onset of focal neurologic deficits resulting from a suspected vascular or space occupying lesion especially in immunocompromised hosts. Only a high index of suspicion, an aggressive approach to diagnosis, and rapid vigorous therapy can alter the clinical course in this group of patients.

Highlights

Fungal infections of the central nervous system (CNS) are almost always a clinical surprise.[1]
The diagnosis of fungal infections relies on microscopy, culture and pathogen specific tests.[2]
Because of the limitations in antemortem clinical diagnosis owing to lack of sensitive diagnostic tools, information regarding frequency and pathogenesis of fungal infections is largely dependent on autopsy studies.[3]

Summary

1.Introduction

Shweta Rana et al / Cerebral Aspergillosis on autopsy investigated and died due to lack of appropriate diagnosis and treatment. We received a post-mortem Brain (bilateral cerebral hemispheres) specimen of a 26 year’s old female for histopathological examination. There was history of sudden severe headache, vomiting, blurring of vision, high grade fever, dizziness only three days before her death. No CSF examination, blood culture or serological tests were conducted Bilateral cerebral hemispheres were received for histopathological examination. Prominent fungal elements in hyphal forms showing septation and acute angle branching in the meningeal blood vessels and in occasional intracerebral vessels were seen (Fig.1a & 1b).

3.Discussion

4.Conclusion