title: Cerebral aspergillosis in a patient with leprosy and diabetes: a case report.
abstract: BACKGROUND
  Opportunistic fungi are dispersed as airborne, ground and decaying matter. The second most frequent extra-pulmonary disease by Aspergillus is in the central nervous system.
  
  
  METHODS
  The case subject was 55 years old, male, mulatto, and an assistant surveyor residing in Teresina, Piauí. He presented with headache, seizures, confusion, fever and left hemiparesis upon hospitalization in 2006 at Hospital São Marcos. Five years previously, he was diagnosed with diabetes mellitus, and 17 months previously he had acne margined by hyperpigmented areas and was diagnosed with leprosy. Laboratory tests indicated leukocytosis and magnetic resonance imaging showed an infarction in the right cerebral hemisphere. Cerebrospinal fluid examination showed 120 cells/mm(3) and was alcohol-resistant bacilli negative. Trans-sphenoidal surgery with biopsy showed inflammation was caused by infection with Aspergillus fumigatus. We initiated use of parenteral amphotericin B, but his condition worsened. He underwent another surgery to implant a reservoir of Ommaya-Hickmann, a subcutaneous catheter. We started liposomal amphotericin B 5 mg/kg in the reservoir on alternate days. He was discharged with a prescription of tegretol and fluconazole.
  
  
  CONCLUSIONS
  This report has scientific interest because of the occurrence of angioinvasive cerebral aspergillosis in a diabetic patient, which is rarely reported. In conclusion, we suggest a definitive diagnosis of cerebral aspergillosis should not postpone quick effective treatment.
authors.forename: João Batista Alves
authors.initials: JB
authors.lastname: Segundo
authors.forename: Marcos Antonio Custódio Neto
authors.initials: MA
authors.lastname: da Silva
authors.forename: Walbert Edson Muniz
authors.initials: WE
authors.lastname: Filho
authors.forename: Anna Cyntia Brandão
authors.initials: AC
authors.lastname: Nascimento
authors.forename: Flávia Castello Branco
authors.initials: FC
authors.lastname: Vidal
authors.forename: Geusa Felipa de Barros
authors.initials: GF
authors.lastname: Bezerra
authors.forename: Graça Maria de Castro
authors.initials: GM
authors.lastname: Viana
authors.affiliation: Department of Pathology, Nucleum of Basic and Applied Immunology, Federal University of Maranhão, São Luís, Maranhão, Brazil. cnsd_ma@uol.com.br.
authors.forename: Maria do Desterro Soares Brandão
authors.initials: Mdo D
authors.lastname: Nascimento
mesh_terms: D000666:Amphotericin B / Q000008:administration & dosage; D000927:Anticonvulsants / Q000627:therapeutic use; D000935:Antifungal Agents / Q000008:administration & dosage; D001232:Aspergillus fumigatus / Q000302:isolation & purification / Q000472:pathogenicity*; D001706:Biopsy; D002220:Carbamazepine / Q000627:therapeutic use; D054022:Cerebrum / Q000382:microbiology*; D003920:Diabetes Mellitus / Q000175:diagnosis; D015725:Fluconazole / Q000008:administration & dosage; D006801:Humans; D015440:Leprosy, Lepromatous / Q000150:complications* / Q000175:diagnosis; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D020953:Neuroaspergillosis / Q000150:complications / Q000175:diagnosis / Q000188:drug therapy / Q000382:microbiology*; D011237:Predictive Value of Tests; D012640:Seizures / Q000188:drug therapy / Q000209:etiology; D016896:Treatment Outcome
chemical_list: D000927:Anticonvulsants; D000935:Antifungal Agents; C068538:liposomal amphotericin B; D002220:Carbamazepine; D000666:Amphotericin B; D015725:Fluconazole