title: Intracranial Aspergillosis in an Immunocompetent Young Woman.
abstract: Intracranial aspergillosis (ICA) is very rare in the immunocompetent individuals, usually misdiagnosed as a tumor or an abscess. A high index of clinical suspicion is required in patients who present with focal neurological deficits, headache, or seizures. We report the case of a 25-year-old immunocompetent female, who presented with a 15-month history of headache, seizures, left-sided proptosis and ophthalmoplegia, and right hemiparesis. Recovery from the symptoms and decrease in the lesion size seen on the radiological assessment were achieved through two decompressive craniotomies followed by prolonged combined systemic antifungal therapies. Although the initial neuroimaging suggested a mitotic pathology, the surgical sample confirmed ICA. Now the patient is on single antifungal therapy (Tab. voriconazole, 200 mg twice daily) and doing her daily activities, but with a reduced intelligent quotient. We report a challenging case of ICA where multiple courses of combined antifungal therapies and repeat surgeries paved the way for a good prognosis.
authors.affiliation: Department of Internal Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
authors.forename: Prasan Kumar
authors.initials: PK
authors.lastname: Panda
authors.affiliation: Department of Internal Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India.
authors.forename: Sunil Kumar
authors.initials: SK
authors.lastname: Mavidi
authors.affiliation: Department of Internal Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India. naveet_wig@yahoo.com.
authors.forename: Naveet
authors.initials: N
authors.lastname: Wig
authors.affiliation: Department of Neuro-Radiology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Ajay
authors.initials: A
authors.lastname: Garg
authors.affiliation: Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: Aasma
authors.initials: A
authors.lastname: Nalwa
authors.affiliation: Department of Pathology, All India Institute of Medical Sciences, New Delhi, India.
authors.forename: M C
authors.initials: MC
authors.lastname: Sharma
mesh_terms: D000328:Adult; D000935:Antifungal Agents / Q000627:therapeutic use; D001230:Aspergillus / Q000302:isolation & purification*; D003399:Craniotomy; D005260:Female; D006801:Humans; D020953:Neuroaspergillosis / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000473:pathology* / Q000628:therapy; D059906:Neuroimaging; D016896:Treatment Outcome
chemical_list: D000935:Antifungal Agents
keywords: Combined antifungal therapies; Craniotomy; Intracranial aspergilloma; Invasive aspergillosis; Invasive fungal disease