J Korean Med Sci.  2012 Mar;27(3):317-320. 10.3346/jkms.2012.27.3.317.

Aspergillus-Associated Cerebral Aneurysm Successfully Treated by Endovascular and Surgical Intervention with Voriconazole in Lupus Nephritis Patient

• Kim YC
• Lee H
• Ryu HH
• Beom SH
• Yang Y
• Kim S
• Chin HJ

• KMID: 1793005
• DOI: http://doi.org/10.3346/jkms.2012.27.3.317

Abstract

During the last five decades, long-term therapy with immunosuppressive agents such as pulse cyclophosphamide in conjunction with high-dose corticosteroids has enhanced both patient survival and renal survival in patients with diffuse proliferative lupus nephritis. Nevertheless, severe side effects such as infectious complications remain the main cause of morbidity and mortality. Central nervous system aspergillosis is uncommon but life-threatening in lupus patients. In this single-patient case study, carotid aneurysm with sphenoidal sinusitis was suspected when severe epistaxis occurred during cyclophosphamide pulse therapy. With anti-fungal therapy, a graft stent was successfully deployed to the aneurysm and specimens of sphenoidal mucosa showed typical hyphae, indicating aspergillosis. Three months after stopping voriconazole treatment, two cerebral aneurysms that were revealed on MR images were successfully removed by aneurysmal clipping. The patient remained alive at one-year follow-up with lupus nephritis in remission. The rarity and high mortality of aspergillus-related fungal aneurysms have led to most cases being recognized postmortem. However, such aneurysms must be diagnosed early to prevent fatal complications by performing appropriate management such as surgical procedure or endovascular intervention.

Keyword

Lupus Nephritis; Neuroaspergillosis; Intracranial Aneurysm; Voriconazole; Endovascular Procedure

MeSH Terms

Antifungal Agents/therapeutic use
Female
Humans
Immunosuppressive Agents/adverse effects
Intracranial Aneurysm/drug therapy/*etiology/surgery
Lupus Nephritis/*complications/drug therapy
Middle Aged
Neuroaspergillosis/drug therapy/*etiology/surgery
Pyrimidines/therapeutic use
Stents
Surgical Instruments
Triazoles/therapeutic use

Figure

• 

  Fig. 1 (A) Aneurysm involving the cavernous segment of the left carotid artery in transfemoral cerebral angiography (black arrow). (B) Cerebral angiography after deploying graft stent in cavernous internal carotid artery for parent vessel reconstruction.

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  Fig. 2 (A) Aneurysm at right middle cerebral artery bifurcation (black arrow) and tiny aneurysm at the origin of right anterior choroidal artery (white arrow). (B) Cerebral angiography after aneurismal clipping.

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