Stroke due to septic embolism resulting from Aspergillus aortitis in an immunocompetent patient.
BACKGROUND
Cerebral infarction secondary to Aspergillus arteritis or septic embolism is an exceptional finding. We present a case of multiple systemic embolism and cerebral infarction resulting from Aspergillus aortitis in an immunocompetent patient.


METHODS
A 65-year-old male with hypertension, hyperglycaemia and myocardial infarction with aorto-coronary by-pass surgery three years before admission, that suffered cerebral infarction in middle right cerebral artery territory and right cubital artery embolism. One month later he presented abrupt increase of his left hemiparesia and left central facial palsy associated with fever of unknown origin. Laboratory test, cranial CT and echocardiogram were performed. He died ten days later.


RESULTS
Hemogram: leucocytes 34.700/microL (85% N, 4.8%L). Cranial CT: cerebral infarction in middle right cerebral artery territory. Transthoracic and transesophageal echocardiogram: moderate left ventricular hypertrophy and slight inferior hypokinesis. Arteriography: complete thrombosis of the left internal carotid. Necropsy: parietal aortic aspergillosis with generalized septic embolisms (brain, kidney, liver, fingers), cerebral infarction in middle right cerebral artery territory and thrombosis of the left carotid siphon with Aspergillus arteritis.


CONCLUSIONS
Aspergillosis is an exceptional cause of cerebral infarction, especially in immunocompetent patients, and their diagnosis is complicated, being usually found at necropsy.
Abenza-Abildua
M J
MJ
Neurology Department, Hospital Universitario La Paz, Paseo de la Castellana 261, 28046, Madrid, Spain. mariajoaa@yahoo.es
Fuentes-Gimeno
B
B
Morales-Bastos
C
C
Aguilar-Amat
M J
MJ
Martinez-Sanchez
P
P
Diez-Tejedor
E
E
D000368:Aged; D001025:Aortitis / Q000150:complications* / Q000382:microbiology; D001132:Arm / Q000098:blood supply; D001157:Arterial Occlusive Diseases / Q000209:etiology*; D001167:Arteritis / Q000150:complications / Q000382:microbiology; D001228:Aspergillosis / Q000150:complications*; D002341:Carotid Artery Thrombosis / Q000209:etiology; D001026:Coronary Artery Bypass; D017809:Fatal Outcome; D006801:Humans; D007121:Immunocompetence; D020243:Infarction, Anterior Cerebral Artery / Q000209:etiology*; D020244:Infarction, Middle Cerebral Artery / Q000209:etiology*; D020766:Intracranial Embolism / Q000209:etiology*; D007668:Kidney / Q000098:blood supply; D008099:Liver / Q000098:blood supply; D008297:Male; D009203:Myocardial Infarction / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology* / Q000382:microbiology; D013923:Thromboembolism / Q000209:etiology*