Cerebral aspergillosis in a patient with leprosy and diabetes: a case report

• Published in: BMC research notes Vol. 7; no. 1; p. 689
• Main Authors: Segundo, João Batista Alves, da Silva, Marcos Antonio Custódio Neto, Filho, Walbert Edson Muniz, Nascimento, Anna Cyntia Brandão, Vidal, Flávia Castello Branco, Bezerra, Geusa Felipa de Barros, Viana, Graça Maria de Castro, Nascimento, Maria do Desterro Soares Brandão
• Format: Journal Article
• Language: English
• Published: England BioMed Central Ltd 04.10.2014; BioMed Central
• Subjects: Amphotericin B - administration & dosage; Anticonvulsants - therapeutic use; Antifungal Agents - administration & dosage; Aspergillosis; Aspergillus fumigatus; Aspergillus fumigatus - isolation & purification; Aspergillus fumigatus - pathogenicity; Biopsy; Carbamazepine - therapeutic use; Care and treatment; Case Report; Cerebrum - microbiology; Diabetes Mellitus - diagnosis; Diagnosis; Fluconazole - administration & dosage; Health aspects; Humans; Leprosy, Lepromatous - complications; Leprosy, Lepromatous - diagnosis; Magnetic Resonance Imaging; Male; Middle Aged; Neuroaspergillosis - complications; Neuroaspergillosis - diagnosis; Neuroaspergillosis - drug therapy; Neuroaspergillosis - microbiology; Patient outcomes; Predictive Value of Tests; Seizures - drug therapy; Seizures - etiology; Treatment Outcome
• ISSN: 1756-0500; 1756-0500
• DOI: 10.1186/1756-0500-7-689

Opportunistic fungi are dispersed as airborne, ground and decaying matter. The second most frequent extra-pulmonary disease by Aspergillus is in the central nervous system. The case subject was 55 years old, male, mulatto, and an assistant surveyor residing in Teresina, Piauí. He presented with headache, seizures, confusion, fever and left hemiparesis upon hospitalization in 2006 at Hospital São Marcos. Five years previously, he was diagnosed with diabetes mellitus, and 17 months previously he had acne margined by hyperpigmented areas and was diagnosed with leprosy. Laboratory tests indicated leukocytosis and magnetic resonance imaging showed an infarction in the right cerebral hemisphere. Cerebrospinal fluid examination showed 120 cells/mm(3) and was alcohol-resistant bacilli negative. Trans-sphenoidal surgery with biopsy showed inflammation was caused by infection with Aspergillus fumigatus. We initiated use of parenteral amphotericin B, but his condition worsened. He underwent another surgery to implant a reservoir of Ommaya-Hickmann, a subcutaneous catheter. We started liposomal amphotericin B 5 mg/kg in the reservoir on alternate days. He was discharged with a prescription of tegretol and fluconazole. This report has scientific interest because of the occurrence of angioinvasive cerebral aspergillosis in a diabetic patient, which is rarely reported. In conclusion, we suggest a definitive diagnosis of cerebral aspergillosis should not postpone quick effective treatment.