title: Aspergillus-associated cerebral aneurysm successfully treated by endovascular and surgical intervention with voriconazole in lupus nephritis patient.
abstract: During the last five decades, long-term therapy with immunosuppressive agents such as pulse cyclophosphamide in conjunction with high-dose corticosteroids has enhanced both patient survival and renal survival in patients with diffuse proliferative lupus nephritis. Nevertheless, severe side effects such as infectious complications remain the main cause of morbidity and mortality. Central nervous system aspergillosis is uncommon but life-threatening in lupus patients. In this single-patient case study, carotid aneurysm with sphenoidal sinusitis was suspected when severe epistaxis occurred during cyclophosphamide pulse therapy. With anti-fungal therapy, a graft stent was successfully deployed to the aneurysm and specimens of sphenoidal mucosa showed typical hyphae, indicating aspergillosis. Three months after stopping voriconazole treatment, two cerebral aneurysms that were revealed on MR images were successfully removed by aneurysmal clipping. The patient remained alive at one-year follow-up with lupus nephritis in remission. The rarity and high mortality of aspergillus-related fungal aneurysms have led to most cases being recognized postmortem. However, such aneurysms must be diagnosed early to prevent fatal complications by performing appropriate management such as surgical procedure or endovascular intervention.
authors.affiliation: Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
authors.forename: Yong Chul
authors.initials: YC
authors.lastname: Kim
authors.forename: Hajeong
authors.initials: H
authors.lastname: Lee
authors.forename: Han Hee
authors.initials: HH
authors.lastname: Ryu
authors.forename: Seung Hoon
authors.initials: SH
authors.lastname: Beom
authors.forename: Yaewon
authors.initials: Y
authors.lastname: Yang
authors.forename: Suhnggwon
authors.initials: S
authors.lastname: Kim
authors.forename: Ho Jun
authors.initials: HJ
authors.lastname: Chin
mesh_terms: D000935:Antifungal Agents / Q000627:therapeutic use; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects; D002532:Intracranial Aneurysm / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D008181:Lupus Nephritis / Q000150:complications* / Q000188:drug therapy; D008875:Middle Aged; D020953:Neuroaspergillosis / Q000188:drug therapy / Q000209:etiology* / Q000601:surgery; D011743:Pyrimidines / Q000627:therapeutic use; D015607:Stents; D013525:Surgical Instruments; D014230:Triazoles / Q000627:therapeutic use; D065819:Voriconazole
chemical_list: D000935:Antifungal Agents; D007166:Immunosuppressive Agents; D011743:Pyrimidines; D014230:Triazoles; D065819:Voriconazole