Fatal Case of a Cerebral and Pulmonary Aspergillosis in an HIV-Infected Patient

Abstract

Introduction: Cerebral aspergillosis is a rare and very severe pathology, usually affecting immunocompromised patients, for whom early antifungal treatment is necessary. Because of the clinical and microbiological diagnostic difficulty, brain imaging is crucial for the positive and differential diagnosis. However, the scannographic and MRI appearance is not very specific, as aspergillosis lesions classically present as multiple rounded images, with or without a hemorrhagic component, with or without annular enhancement after contrast injection. Diffusion imaging may present a more specific aspect and help in early diagnosis. Case Report: The patient was 48 years old and had been followed for 4 months for positive HIV infection at the AIDS stage. She presented with a sudden onset of HTIC syndrome (headache, vomiting and confusion) in a febrile context.On admission, the clinical examination found a stable patient on the HD and respiratory plan, BMI: 16 kg/m2, polypneic at 28cpm, febrile at 39°the other constants are normal (FC: 90 b/mn, BP: 11/8 cmHg, FR: 28 c/mn. The somatic examination was without particularities. The biological workup showed white blood cells at 14900 (PNN: 13800) and CD4 lymphocytes at 45/mm.The evolution was marked by the occurrence of acute respiratory distress 3 days later with an elevated D-Dimer level of 740 µg/L. A thoracic angioscan was performed to rule out pulmonary embolism. Aspergillosis serology was performed: positive. The diagnosis of cerebral aspergillosis by dissemination from the pulmonary focus was retained. The patient died within 24 hours. Conclusion: Morphological imaging of cerebral aspergillosis lesions is not very specific. Knowledge of their appearance on diffusion imaging (global restriction of water diffusion or heterogeneous "target" appearance) can provide valuable assistance in the positive and differential diagnosis of aspergillosis.