Isolated cerebral aspergillosis in immunocompetent patients.
BACKGROUND
Isolated cerebral aspergillosis (ICA) traditionally has been associated with immunocompromised patients with dismal outcomes. Cases of ICA in immunocompetent patients are very rare and poorly described. We describe our experience of 5 immunocompetent patients with ICA and compare our experience with the literature.


METHODS
During the period 1996-2011, ICA was diagnosed in 5 otherwise healthy, immunocompetent patients at our institution. Medical records of the patients were reviewed with standardized data collection, including demographics, clinical presentation, radiologic features, histopathology results, treatment, and outcome.


RESULTS
All 5 patients had radiologic evidence of cerebral disease, purely parenchymal in 4 patients and dural-based in 1 patient. Radiology showed the paranasal sinuses and lungs to be clear in all patients. All patients underwent resection with antifungal therapy. All patients were female with a mean age of 23 years (range, 13-36 years). Headache (n = 5) and seizures (n = 4) were the primary presenting manifestations. Brain magnetic resonance imaging was performed in 5 patients preoperatively, and computed tomography was performed preoperatively in 4 patients. The diagnosis was made by histopathology (n = 5) and fungal cultures (n = 3) of the excised mass. Surgical resection was performed in all patients followed by treatment with amphotericin B for 2-4 weeks then oral voriconazole for 6 months. Overall mortality was 20% (n = 1). Average follow-up period was 32 months (range, 12-51 months) with interval brain magnetic resonance imaging to document eradication.


CONCLUSIONS
ICA in otherwise healthy immunocompetent hosts seems to have a more favorable prognosis than what is reported for immunocompromised hosts.
Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Rakan
R
Bokhari
Division of Neurosurgery, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia. Electronic address: sbaeesa@kau.edu.sa.
Saleh
S
Baeesa
Department of Pathology, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Jaudah
J
Al-Maghrabi
Department of Medicine, Faculty of Medicine, King Abdulaziz University, Jeddah, Saudi Arabia.
Tariq
T
Madani
D000293:Adolescent; D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001228:Aspergillosis / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D002494:Central Nervous System Infections / Q000175:diagnosis / Q000601:surgery / Q000628:therapy*; D005260:Female; D006261:Headache / Q000209:etiology; D006801:Humans; D007091:Image Processing, Computer-Assisted; D007121:Immunocompetence; D008279:Magnetic Resonance Imaging; D008297:Male; D019635:Neurosurgical Procedures; D010291:Paresis / Q000209:etiology; D011379:Prognosis; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D055815:Young Adult
D000935:Antifungal Agents
Aspergillosis; Cerebral; Fungal infection; Immunocompetent hosts; Surgery