April 8, 2013
A 61-year-old woman with history of angioimmunoblastic T cell lymphoma presents with fever, syncope, and headache.
CNS Aspergillosis
- CNS Aspergillosis is caused by Aspergillus sp., a fungus that may present as an abscess or granuloma, generally seen when the host's defense system is unable to isolate or encapsulate the offending organisms (immunocompromised patients). The infection mostly occurs through hematogenous dissemination from lung infection or direct extension from paranasal sinuses. It can also cause angioinvasive disease with high fatality rate, especially in immunosuppressed patients.
- Clinical Presentation: Headache, seizures, focal neurological deficit, mental status change
- Key Diagnostic Features: MRI features are those of a brain abscess: a central necrotic component demonstrating diffusion restriction and a surrounding ring of enhancement. Foci of susceptibility can be seen within the lesion and contribute to the heterogeneity within it. These likely represent blood products, iron, manganese, and magnesium in the fungal concretions. In the angioinvasive disease, brain infarcts may be seen with or without hemorrhage.
- DDx: Lymphoma, cryptococosis, toxoplasmosis, candidiasis
- Rx: Antifungal treatment, neurosurgical intervention
