Infect Chemother.  2013 Jun;45(2):225-229. 10.3947/ic.2013.45.2.225.

A Case of Acute Cerebral Aspergillosis Complicating Influenza A/H1N1pdm 2009

• Kim MJ
• Kim MK
• Kang CK
• Jun KI
• Bang JH
• Park SW
• Oh MD

• KMID: 2285004
• DOI: http://doi.org/10.3947/ic.2013.45.2.225

Abstract

Invasive aspergillosis is a rare complication in patients with influenza infection. Several cases of invasive pulmonary aspergillosis accompanying influenza infections were reported during the influenza A/H1N1pdm 2009. We encountered a case of acute cerebral aspergillosis in a patient with influenza A/H1N1pdm 2009 infection. A 24-year-old man with uncontrolled diabetes was diagnosed with influenza A/H1N1pdm 2009 infection. Initial evaluation indicated methicillin-sensitive Staphylococcus aureus pneumonia and diabetic ketoacidosis along with influenza. During his hospital course, multiple new rim-enhancing mass lesions not evident in the initial evaluation developed in the fronto-parietal cortical and subcortical white matter and right cerebellum. Pathology and culture results confirmed the presence of Aspergillus fumigatus. Surgical drainage combined with a total of 18 weeks of antifungal therapy resulted in complete resolution of the infection. This case demonstrates that cerebral aspergillosis can present alongside influenza in patients with diabetes or those under intensive care. Clinical suspicion of invasive aspergillosis is required for a definite diagnosis and better prognosis in such cases.

Keyword

Central nervous system; Invasive aspergillosis; Influenza; Brain abscess; Diabetes mellitus

MeSH Terms

Aspergillosis
Aspergillus fumigatus
Brain Abscess
Central Nervous System
Cerebellum
Critical Care
Diabetes Mellitus
Diabetic Ketoacidosis
Drainage
Humans
Influenza, Human
Invasive Pulmonary Aspergillosis
Pneumonia, Staphylococcal
Prognosis

Figure

• 

  Figure 1 Sequence of clinical and laboratory events. Reverse transcription-polymerase chain reaction for H1N1 virus was performed serially by nasopharyngeal swab (HD #-3, 2, 10, and 19) and CSF (HD #8 and 14). Initial chest radiography (A) showed multiple patchy consolidations. MRI showed a vague rim-enhancing mass lesion on HD #8 (B), and the abscess became evident on HD #27 (C). The lesion disappeared after surgery and 18 weeks of anti-fungal therapy (D). MSSA, methicillin-sensitive Staphylococcus aureus ; GM, galactomannan; NP, nasopharynx; CSF, cerebrospinal fluid; CRRT, continuous renal replacement therapy; HD, hospital day. HD #1 indicates the day of admission.

• 

  Figure 2 Brain abscess pathology. Gomori methenamine-silver (A), and periodic acid-Schiff stains (B) revealed fungal hyphae.

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