P287 A case of cerebral aspergillosis in Sri Lanka

Abstract

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM IntroductionCerebral aspergillosis is a rare disease entity that is usually associated with high mortality. In accordance with most systemic fungal infections, immunocompromised patients are the predominant victims affected. Nonspecific clinical and radiological features may contribute to difficulty and delay in diagnosis, further contributing to the poor prognosis of cerebral aspergillosis. Obtainment of proper specimens for laboratory diagnosis is a key to make a timely diagnosis that may be lifesaving.Case ReportA 74-year-old female presented with a frontal headache for 2 weeks’ duration. She had been diagnosed with a low-grade lymphoma and had completed the chemotherapy and high-dose prednisolone 4 weeks prior to this presentation. Other than the frontal headache, which progressed slowly over 2 weeks, she did not disclose any associated symptoms. Physical examination was normal, with neither sign of raised intracranial pressure nor of a CNS infection. Basic investigations revealed no abnormalities, and the white cell count was 7.5 × 109/l and the CRP was 7 mg/l.An MRI of the brain indicated right frontal sinusitis with a secondary small abscess in the right frontal lobe inferiorly. Therefore, she was treated with parenteral antibiotics for a bacterial infection and was discharged.The patient presented with a headache again after 3 months. A repeat MRI of the brain revealed an increase in the size of the lesion in the right frontal lobe and the possibility of a cerebral tumor was suggested. A diagnostic biopsy was performed, and the specimen was subjected to fungal studies. The direct microscopic examination revealed fungal filaments and the culture yielded a pure growth of Aspergillus fumigatus.She was started on intravenous amphotericin B, followed by oral voriconazole. Her headache gradually subsided with antifungal therapy. The duration of therapy was guided by serial radiological imaging, and the patient achieved a complete recovery at the end of 1-year of treatment. She remains asymptomatic to date, after 2 years of treatment completion.DiscussionImmunocompromised patients with cerebral aspergillosis may present with minimal clinical symptoms and signs. Obtaining a proper specimen for laboratory testing is vital to arrive at a definitive diagnosis. Radiological investigations may play an important role in the diagnosis as well as during the follow-up of a patient with cerebral aspergillosis. Appropriate antifungal treatment for a prolonged duration, with or without neurosurgical intervention and reversal or reduction of immunosuppressive therapy leads to a good prognosis.