J Korean Neurosurg Soc.  2013 May;53(5):312-315. 10.3340/jkns.2013.53.5.312.

Cerebral Aspergillosis with Multiple Enhancing Nodules in the Right Cerebral Hemisphere in the Immune-Competent Patient

• Lee GJ
• Jung TY
• Choi SM
• Jung MY

• KMID: 1426203
• DOI: http://doi.org/10.3340/jkns.2013.53.5.312

Abstract

Aspergillosis in the central nervous system (CNS) is a very rare disease in immune-competent patients. There was a case of a healthy man without a history of immune-compromised disease who had invasive aspergillosis with unusual radiologic findings. A 48-year-old healthy man with diabetes mellitus, presented with complaints of blurred vision that persisted for one month. Brain magnetic resonance imaging (MRI) showed multiple nodular enhancing lesions on the right cerebral hemisphere. The diffusion image appeared in a high-signal intensity in these areas. Cerebrospinal fluid examination did not show any infection signs. An open biopsy was done and intraoperative findings showed grayish inflammatory and necrotic tissue without a definitive mass lesion. The pathologic result was a brain abscess caused by fungal infection, morphologically aspergillus. Antifungal agents (Amphotericin B, Ambisome and Voriconazole) were used for treatment for 3 months. The visual symptoms improved. There was no recurrence or abscess pocket, but the remaining focal enhanced lesions were visible in the right temporal and occipital area at a one year follow-up MRI. This immune-competent patient showed multiple enhancing CNS aspergillosis in the cerebral hemisphere, which had a good outcome with antifungal agents.

Keyword

Aspergillosis; Cerebral; Enhancement; Immune-competent; Multiple

MeSH Terms

Abscess
Amphotericin B
Antifungal Agents
Aspergillosis
Aspergillus
Biopsy
Brain
Brain Abscess
Central Nervous System
Cerebrum
Diabetes Mellitus
Diffusion
Follow-Up Studies
Humans
Magnetic Resonance Imaging
Rare Diseases
Recurrence
Vision, Ocular
Amphotericin B
Antifungal Agents

Figure

• 

  Fig. 1 Radiologic findings. A and B : In brain MRI, there are low-signal intensity on T1-wighted axial images and high-signal intensities in the T2-weighed axial image on right occipital cortex. C and D : Multiple enhancing nodules with necrotic change are shown in right frontotemporoparietal cortex and white matter. E : In diffusion MRI, the high-signal intensity lesions are shown in right frontotemporoparietal cortex and white matter. F : The recurrence does not appear in the right temporal and occipital area with remaining focal enhanced lesions.

• 

  Fig. 2 Operative and pathologic findings. A : There was no definitive mass lesion, but reddish tissues of the cortex and the thickened yellowish arachnoid membrane are shown. B : In the biopsy, there are shown the hyphaes with the positive periodic acid-shiff staining (original magnification ×200).

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