July 2014
A 55-year-old man is referred to the ER for unusual headaches.
Medical History: Liver transplantation (chronic HCV infection associated with hepatocellular carcinoma and CHILD C Cirrhosis)
Angioinvasive Aspergillosis of the Brain
- Clinical Features: Angioinvasive aspergillosis mainly affects immunocompromised patients, but can also occur in immunocompetent patients, especially those with diabetes. CNS involvement often results from dissemination of the infection from the lungs and paranasal sinuses.
- Key Diagnostic Features:
- Rapidly progressive, ischemic arteritis (with involved vessels demonstrating a beaded appearance and irregular nodular enhancement) in an immunocompromised patient should raise a red flag for this disease entity.
- Occasionally, aneurysms can be seen.
- Associated parenchymal findings include:
- Ischemic lesions with restricted diffusion
- Ring-enhancing lesions, most often with central necrotic restricted diffusion (abscess). Occasionally, peripheral diffusion restriction can be seen and could be related to hemorrhage or presence of iron and manganese (high T1 and low T2 signal).
- It is essential to look for involvement of the paranasal sinuses and orbits when presented with angioinvasive CNS aspergillosis.
- DDx: Lymphoma, toxoplasmosis, tuberculosis, metastasis
- Rx: Aggressive antifungal therapy, neurosurgical intervention
