J Korean Soc Magn Reson Med.  2010 Jun;14(1):64-68. 10.13104/jksmrm.2010.14.1.64.

Isolated Aspergillosis of the Brain in an Immunocompetent Patient: A Case Report

• Lim J
• Chung TS
• Kim H
• Ahn JY
• Suh SH

• KMID: 1782995
• DOI: http://doi.org/10.13104/jksmrm.2010.14.1.64

Abstract

Brain aspergillosis has been increasing remarkably. They are known to occur commonly in immunocompromised individuals by hematogenous spread from other primary sites or by direct extension from adjacent structures to central nervous system. We report a rare case of a 29-year-old male without any known medical history, who had isolated brain lesion and the pathology from stereotactic biopsy confirmed cerebral aspergillosis.

Keyword

Central nervous system; Aspergillosis; Immunocompetent; MRI; Fungal infection

MeSH Terms

Adult
Aspergillosis
Biopsy
Brain
Central Nervous System
Humans
Male

Figure

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  Fig. 1 A 29-year-old man presented with fever and intractable headache. (a) Brain CT depicts ill defined hypodensity lesion in the right basal ganglia and right internal capsule area with mild mass effect to ipsilateral ventricle. (b and c) Brain MR T2 weighted coronal and axial images reveal confluent configuration of the abscess in right basal ganglia and internal capsule area extending to adjacent corona radiata and thalamus with perilesional edema upward to frontoparietal white matter, corpus callosum and downward to pons. Smaller satellite lesion was also noted at right parieto-occipital subcortical area. (d) On Gadolinium-enhanced MR T1-weighted images, irregular wall enhancement along the margin of the abscess is noted. (e) The center of the fungal abscess shows diffusion restriction presenting central high signal intensity within low signal intensity capsule on DWI.

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  Fig. 2 Stereotactic Biopsy of the lesion with D-PAS staining on high power field shows acute inflammatory cells with hemorrhage and a few fungal hyphae. The fungal hyphae show true septations and branching pattern with acute angle, morphologically consistent with aspergillus.

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  Fig. 3 Follow up MRI was undertaken owing to deteriorated patient's status. (a and b) Increased size of abscess in the right basal ganglia with aggravated perilesional edema on T2-weighted and Gondolinium-enhanced T1-weighted images is noted. Newly developed hydrocephalus in contralateral side is also demonstrated due to mass effect. (c) Two weeks after modification in antifungal medication, additional brain CT depicted improvement of the lesional edema.

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  Fig. 4 Slightly above the level of figure 1a, there was small hypointense rod-shaped lesion in the center of hyperintense abscess core on T2-weighted MR images (arrow), which is thought to be dense aspergillus hyphal elements and paramagnetic elements.

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