CNS-manifestation of aspergillosis in an extremely low-birth-weight infant.
Invasive aspergillosis is a rare condition in term and preterm infants. We present here the fatal case of a 28-week gestational age preterm baby who developed pulmonary, hepatic and central nervous system aspergillosis during the first days of life. A hyperechogenic lesion adjacent to the lateral ventricle was diagnosed by ultrasound and initially considered to represent periventricular leukomalacia. Within several days the lesion increased in size and was then falsely considered to be an intraventricular haemorrhage. Aspergillus fumigatus was ultimately isolated in the tracheal aspirates, ascites and in material recovered by open brain biopsy. Despite treatment with conventional and liposomal amphotericin B the infant patient died.


CONCLUSIONS
Invasive aspergillosis has to be considered in the differential diagnosis of an unusual hyperechogenic brain lesion in very low-birth-weight infants with persistent symptoms and signs of systemic infection despite broad-spectrum antibacterial therapy. Consideration of this diagnosis should result in an aggressive diagnostic work-up to allow early initiation of an appropriate treatment.
Fuchs
Hans
H
Division of Neonatology and Pediatric Critical Care, Department of Pediatrics, Children's Hospital, University of Ulm, Eythstr. 24, 89075 Ulm, Germany. hans.fuchs@medizin.uni-ulm.de
von Baum
Heike
H
Meth
Martina
M
Wellinghausen
Nele
N
Lindner
Wolfgang
W
Hummler
Helmut
H
D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology; D001232:Aspergillus fumigatus / Q000302:isolation & purification; D020314:Central Nervous System Fungal Infections / Q000175:diagnosis* / Q000188:drug therapy / Q000382:microbiology*; D003937:Diagnosis, Differential; D017809:Fatal Outcome; D006801:Humans; D052577:Infant, Extremely Low Birth Weight; D007231:Infant, Newborn; D008297:Male; D014430:Twins, Monozygotic
D000935:Antifungal Agents