Infect Chemother.  2012 Oct;44(5):395-398. 10.3947/ic.2012.44.5.395.

Disseminated Invasive Aspergillosis with Multiple Brain Abscess after Allogeneic Hematopoietic Stem Cell Transplantation Treated Successfully with Voriconazole and Neurosurgical Intervention

• Im JH
• Park IS
• Kim EY
• Lee JS
• Lim JH
• Lee MH
• Kim CS
• Lee HJ
• Yi HG

• KMID: 2170387
• DOI: http://doi.org/10.3947/ic.2012.44.5.395

Abstract

Invasive aspergillosis is a serious infectious complication, which can occur after hematopoietic stem cell transplantation (HSCT). In particular, despite antifungal treatment, invasive aspergillosis involving the central nervous system (CNS) shows very high mortality. In principle, a neurosurgical procedure with an antifungal agent is recommended for treatment of CNS invasive aspergillosis. We encountered a patient suffering from disseminated invasive aspergillosis involving the lung, brain, and soft tissues after allogeneic HSCT for treatment of relapsed acute myeloid leukemia who was cured with voriconazole and stereotactic drainage of the brain abscess.

Keyword

Invasive aspergillosis; Central nervous system; Hematopoietic stem cell transplantation; Neurosurgical procedure; Voriconazole

MeSH Terms

Aspergillosis
Brain
Brain Abscess
Central Nervous System
Drainage
Hematopoietic Stem Cell Transplantation
Hematopoietic Stem Cells
Humans
Leukemia, Myeloid, Acute
Lung
Neurosurgical Procedures
Pyrimidines
Stress, Psychological
Triazoles
Pyrimidines
Triazoles

Figure

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  Figure 1 Subcutaneous erythematous nodules with central necrosis on forehead and left leg.

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  Figure 2 (A) Chest CT at diagnosis of invasive pulmonary aspergillosis; There was a cavitary lesion with abscess in left lower lung. (B) After treatment with voriconazole for 150 days, the lesion is much improved.

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  Figure 3 (A) Brain MRI with enhancement at diagnosis of CNS aspergillosis; There is a mass with peripheral enhancement suggesting fungal abscess in right cerebral hemisphere. (B) After treatment with stereotactic aspiration of abscess and voriconazole for 150 days, the lesion is much improved.

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  Figure 4 Septated, acute-angle, and branched hyphae with regular width and shape are visible from aspirates of brain abscess. Grocott-Gomori methenamine silver stain, ×400.

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