title: Cerebral aspergillosis with multiple enhancing nodules in the right cerebral hemisphere in the immune-competent patient.
abstract: Aspergillosis in the central nervous system (CNS) is a very rare disease in immune-competent patients. There was a case of a healthy man without a history of immune-compromised disease who had invasive aspergillosis with unusual radiologic findings. A 48-year-old healthy man with diabetes mellitus, presented with complaints of blurred vision that persisted for one month. Brain magnetic resonance imaging (MRI) showed multiple nodular enhancing lesions on the right cerebral hemisphere. The diffusion image appeared in a high-signal intensity in these areas. Cerebrospinal fluid examination did not show any infection signs. An open biopsy was done and intraoperative findings showed grayish inflammatory and necrotic tissue without a definitive mass lesion. The pathologic result was a brain abscess caused by fungal infection, morphologically aspergillus. Antifungal agents (Amphotericin B, Ambisome and Voriconazole) were used for treatment for 3 months. The visual symptoms improved. There was no recurrence or abscess pocket, but the remaining focal enhanced lesions were visible in the right temporal and occipital area at a one year follow-up MRI. This immune-competent patient showed multiple enhancing CNS aspergillosis in the cerebral hemisphere, which had a good outcome with antifungal agents.
authors.affiliation: Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hwasun Hospital & Medical School, Gwangju, Korea.
authors.forename: Gwang-Jun
authors.initials: GJ
authors.lastname: Lee
authors.forename: Tae-Young
authors.initials: TY
authors.lastname: Jung
authors.forename: Seong-Min
authors.initials: SM
authors.lastname: Choi
authors.forename: Min-Young
authors.initials: MY
authors.lastname: Jung
keywords: Aspergillosis; Cerebral; Enhancement; Immune-competent; Multiple
references.citation: Ann Hematol. 2004;83 Suppl 1:S42-4
references.pmid: 15124667
references.citation: J Neuroimaging. 2007 Oct;17(4):361-6
references.pmid: 17894631
references.citation: Acad Radiol. 2002 Feb;9(2):163-71
references.pmid: 11918369
references.citation: J Neurosurg. 1985 Sep;63(3):371-81
references.pmid: 4020464
references.citation: J Korean Neurosurg Soc. 2011 May;49(5):305-7
references.pmid: 21716631
references.citation: Neurosurgery. 1983 Sep;13(3):306-9
references.pmid: 6353266
references.citation: Radiology. 2000 Nov;217(2):331-45
references.pmid: 11058626
references.citation: Clin Infect Dis. 1998 Apr;26(4):781-803; quiz 804-5
references.pmid: 9564455
references.citation: AJNR Am J Neuroradiol. 1995 Mar;16(3):555-62
references.pmid: 7793381
references.citation: Libyan J Med. 2008 Mar 01;3(1):49-51
references.pmid: 21516164
references.citation: AJNR Am J Neuroradiol. 1992 Sep-Oct;13(5):1489-92
references.pmid: 1414847
references.citation: Neuroimaging Clin N Am. 1997 May;7(2):187-98
references.pmid: 9113685
references.citation: AJR Am J Roentgenol. 1994 Jan;162(1):155-9
references.pmid: 8273655
references.citation: Am J Rhinol. 2001 Sep-Oct;15(5):327-31
references.pmid: 11732820
references.citation: Medicine (Baltimore). 2000 Jul;79(4):269-80
references.pmid: 10941356
references.citation: CNS Drugs. 2007;21(8):659-76
references.pmid: 17630818
references.citation: AJNR Am J Neuroradiol. 2005 Apr;26(4):835-8
references.pmid: 15814930
references.citation: Acta Radiol. 2006 May;47(4):408-12
references.pmid: 16739702
references.citation: AJNR Am J Neuroradiol. 1999 Oct;20(9):1597-604
references.pmid: 10543627
references.citation: N Engl J Med. 2002 Aug 8;347(6):408-15
references.pmid: 12167683
references.citation: Int J Med Sci. 2011;8(7):635-9
references.pmid: 22022217
references.citation: J Infect Dev Ctries. 2011 Apr 26;5(4):313-5
references.pmid: 21537076
references.citation: Int J Urol. 2004 Aug;11(8):666-8
references.pmid: 15285760
references.citation: Radiology. 1988 Nov;169(2):439-44
references.pmid: 3174990
references.citation: Clin Infect Dis. 2001 Feb 1;32(3):358-66
references.pmid: 11170942
references.citation: Singapore Med J. 2007 Jan;48(1):e1-4
references.pmid: 17245496
references.citation: Radiographics. 2009 Mar-Apr;29(2):375-9
references.pmid: 19325053
references.citation: Virchows Arch. 2005 Jan;446(1):28-33
references.pmid: 15480762
references.citation: J Clin Neurosci. 2010 Dec;17(12):1587-9
references.pmid: 20800492
references.citation: Radiographics. 2006 Jul-Aug;26(4):1239-42
references.pmid: 16844943