title: [Cervical aspergillosis with dissemination to the central nervous system: Case reports and review of the literature].
abstract: BACKGROUND
  Invasive aspergillosis (IA) of the central nervous system (CNS) is an uncommon condition that usually occurs in immunocompromised patients. This illness can manifest as meningitis, or as a micotic aneurism, stroke or abscess. The infection affects the CNS either primarily or, more often, secondarily via blood dissemination from a distant focus, and has a poor prognosis. We present a patient with IA primarily affecting the cervical bones, with later spread into the brain.
  
  
  METHODS
  A 25-year old male was receiving chemotherapy for acute lymphocytic leukemia when he developed pneumonitis secondary to methotrexate and was started on corticosteroids. He subsequently developed cervicalgia, prompting a needle biopsy of the fourth vertebrae, after which a diagnosis of osteomyelitis was made. Even though the biopsy culture was negative, empirical antibiotics were initiated. A parietal lobe lesion was treated surgically months later after the patient presented with three episodes of transient aphasia. After A. fumigatus grew in culture, the patient's antibiotic regimen was changed to treat the specific agent with a good response.
  
  
  CONCLUSIONS
  IA must be considered a possibility whenever an immunocompromised patient presents with a new brain lesion. These lesions require surgical evacuation, a procedure that allows for diagnostic confirmation and enhances prognosis. Appropriate anti-fungal therapy must be started as soon as the diagnosis is confirmed. In addition, the patient's neurological exam must be repeated and images obtained periodically to monitor treatment and detect possible recurrences.
authors.affiliation: Neurocirujanos del Departamento de Neurocirugía de FLENI, Buenos Aires, Argentina.
authors.forename: Guillermo Enrique
authors.initials: GE
authors.lastname: Vergara
authors.affiliation: Traumatólogos (Neurortopedistas) del Departamento de Neurocirugía de FLENI, Buenos Aires, Argentina.
authors.forename: Natalia
authors.initials: N
authors.lastname: Roura
authors.affiliation: Infectólogos del Departamento de Infectología de FLENI, Buenos Aires, Argentina.
authors.forename: Marcelo
authors.initials: M
authors.lastname: Del Castillo
authors.affiliation: Infectólogos del Departamento de Infectología de FLENI, Buenos Aires, Argentina.
authors.forename: Andrea
authors.initials: A
authors.lastname: Mora
authors.affiliation: Neurocirujanos del Departamento de Neurocirugía de FLENI, Buenos Aires, Argentina.
authors.forename: Santiago Condomi
authors.initials: SC
authors.lastname: Alcorta
authors.affiliation: Neurocirujanos del Departamento de Neurocirugía de FLENI, Buenos Aires, Argentina.
authors.forename: Rubén
authors.initials: R
authors.lastname: Mormandi
authors.affiliation: Neurocirujanos del Departamento de Neurocirugía de FLENI, Buenos Aires, Argentina.
authors.forename: Andrés
authors.initials: A
authors.lastname: Cervio
authors.affiliation: Neurocirujanos del Departamento de Neurocirugía de FLENI, Buenos Aires, Argentina.
authors.forename: Jorge
authors.initials: J
authors.lastname: Salvat