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Memiş KB, Tan E, Aydın S. Invasive Intracranial Aspergillosis in an Immunocompetent Patient. Rev Soc Bras Med Trop 2024; 57:e009132024. [PMID: 38716977 PMCID: PMC11073516 DOI: 10.1590/0037-8682-0106-2024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2024] [Accepted: 04/12/2024] [Indexed: 05/12/2024] Open
Affiliation(s)
- Kemal Buğra Memiş
- Erzincan University, School of Medicine, Department of Radiology, Erzincan, Turkey
| | - Elif Tan
- Erzincan University, School of Medicine, Department of Radiology, Erzincan, Turkey
| | - Sonay Aydın
- Erzincan University, School of Medicine, Department of Radiology, Erzincan, Turkey
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Rai B, Kaushik M, Vijayan K, Mani KK, Shah VM. Aspergillosis of Meckel Cave in an Immunocompetent Patient. J Neuroophthalmol 2024; 44:e123-e124. [PMID: 38109290 DOI: 10.1097/wno.0000000000001848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Affiliation(s)
- Bhagyata Rai
- Neuro-ophthalmology Services (BR, MK, KKM, VMS), Aravind Eye Hospital and Postgraduate Institute of Ophthalmology, Coimbatore, Tamil Nadu, India; and Royal Care Superspeciality Hospital (KV), Coimbatore, Tamil Nadu, India
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Amanati A, Lotfi M, Abdolkarimi B, Karimi Rouzbahani A, Mahmoudvand G. Evolution of neuroimaging findings in angioinvasive cerebral aspergillosis in a pediatric patient with leukemia during long-term observation. BMC Infect Dis 2023; 23:811. [PMID: 37978456 PMCID: PMC10657136 DOI: 10.1186/s12879-023-08483-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/25/2023] [Indexed: 11/19/2023] Open
Abstract
The central nervous system is one of the most common sites of aspergillosis involvement in immunocompromised people, just after sinopulmonary infections. Neuroimaging modalities are crucial for the diagnosis of cerebral aspergillosis (CA). Here, we describe a rare case of concurrent mixed aspergillosis infection with Aspergillus fumigatus and Aspergillus niger in a 2-year-old leukemic boy. The first neuroimaging finding, which was followed by focal seizures, was recognized as extensive cerebral hemorrhage in the absence of thrombocytopenia and coagulopathy. As the patient survived for more than 4 months after diagnosis, we were able to perform a neuroimaging evaluation during long-term observation. In serial neuroimaging studies, a secondary fungal abscess was observed at the site of hemorrhagic infarctions. Finally, the patient died from bacterial sepsis. In this case study, we try to categorize the neuroimaging findings of CA into distinct phases to better understand how CA changes over time.
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Affiliation(s)
- Ali Amanati
- Professor Alborzi Clinical Microbiology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
- Infection Control Unit, Amir Oncology Hospital, Shiraz, Iran
| | - Mehrzad Lotfi
- Medical Imaging Research Center, Department of Radiology, Shiraz University of Medical Sciences, Nemazee Hospital, Nemazee Sq., Zand St., Shiraz, 7193613311, Iran.
| | - Babak Abdolkarimi
- Pediatric Hematology-Oncology, Lorestan University of Medical Sciences, Khorramabad, Iran
| | - Arian Karimi Rouzbahani
- Student Research Committee, Lorestan University of Medical Sciences, Anooshirvan Rezaei Sq., Khorramabad, 6814713115, Lorestan, Iran.
- USERN Office, Lorestan University of Medical Sciences, Khorramabad, Iran.
| | - Golnaz Mahmoudvand
- Student Research Committee, Lorestan University of Medical Sciences, Anooshirvan Rezaei Sq., Khorramabad, 6814713115, Lorestan, Iran
- USERN Office, Lorestan University of Medical Sciences, Khorramabad, Iran
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Alrfaei BM, Almutairi AO, Aljohani AA, Alammar H, Asiri A, Bokhari Y, Aljaser FS, Abudawood M, Halwani M. Electrolytes Play a Role in Detecting Cisplatin-Induced Kidney Complications and May Even Prevent Them-Retrospective Analysis. MEDICINA (KAUNAS, LITHUANIA) 2023; 59:medicina59050890. [PMID: 37241122 DOI: 10.3390/medicina59050890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Revised: 04/19/2023] [Accepted: 04/21/2023] [Indexed: 05/28/2023]
Abstract
Background and Objective: Cisplatin is a chemotherapy drug used to treat several types of malignancies. It is a platinum-based compound that interferes with cell division and DNA replication. Cisplatin has been associated with renal damage. This study evaluates the early detection of nephrotoxicity through routine laboratory tests. Materials and Methods: This is a retrospective chart review based on the Saudi Ministry of National Guard Hospital (MNGHA). We evaluated deferential laboratory tests for cancer patients treated with cisplatin between April 2015 and July 2019. The evaluation included age, sex, WBC, platelets, electrolytes, co-morbidities and interaction with radiology. Results: The review qualified 254 patients for evaluation. Around 29 patients (11.5%) had developed kidney function abnormality. These patients presented with abnormally low magnesium 9 (31%), potassium 6 (20.7%), sodium 19 (65.5%) and calcium 20 (69%). Interestingly, the whole sample size had abnormal electrolytes presenting magnesium 78 (30.8%), potassium 30 (11.9%), sodium 147 (58.1%) and calcium 106 (41.9%). Some pathological features were detected, such as hypomagnesemia, hypocalcemia and hypokalemia. In addition, infections that needed antibiotics were dominant in patients treated with cisplatin alone, representing 50% of this group. Conclusions: We report that an average of 15% of patients with electrolyte abnormalities develop renal toxicity and reduced function. Moreover, electrolytes may serve as an early indicator for renal damage as part of chemotherapy complication. This indication represents 15% of renal toxicity cases. Changes in electrolyte levels have been reported with cisplatin. Specifically, it has been linked to hypomagnesemia, hypocalcemia and hypokalemia. This study will help reduce the risk of dialysis or the need for kidney transplant. It is also important to manage any underlying conditions and control patients' intake of electrolytes.
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Affiliation(s)
- Bahauddeen M Alrfaei
- Cellular Therapy and Cancer Research Department, King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences, Riyadh 14611, Saudi Arabia
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard-Health Affairs, Riyadh 14611, Saudi Arabia
| | - Abdulaziz O Almutairi
- College of Pharmacy, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard-Health Affairs, Riyadh 14611, Saudi Arabia
| | - Alaa A Aljohani
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard-Health Affairs, Riyadh 14611, Saudi Arabia
| | - Hajar Alammar
- College of Medicine, King Saud bin Abdulaziz University for Health Sciences, Ministry of National Guard-Health Affairs, Riyadh 14611, Saudi Arabia
| | - Abdulaziz Asiri
- Faculty of Applied Medical Sciences, University of Bisha, 255, Al Nakhil, Bisha 67714, Saudi Arabia
| | - Yahya Bokhari
- Department of AI and Bioinformatics, King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
- Department of Health Informatics, College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh 11426, Saudi Arabia
| | - Feda S Aljaser
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 12371, Saudi Arabia
| | - Manal Abudawood
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, King Saud University, Riyadh 12371, Saudi Arabia
| | - Majed Halwani
- Nanomedicine Department, King Abdullah International Medical Research Center (KAIMRC), King Saud bin Abdulaziz University for Health Sciences, Riyadh 11481, Saudi Arabia
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Kurokawa M, Kurokawa R, Baba A, Kim J, Tournade C, Mchugh J, Trobe JD, Srinivasan A, Bapuraj JR, Moritani T. Deadly Fungi: Invasive Fungal Rhinosinusitis in the Head and Neck. Radiographics 2022; 42:2075-2094. [PMID: 36178803 DOI: 10.1148/rg.220059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Invasive fungal rhinosinusitis (IFRS) is a serious infection that is associated with high morbidity and mortality rates. The incidence of IFRS has been increasing, mainly because of the increased use of antibiotics and immunosuppressive drugs. Rhino-orbital cerebral mucormycosis has recently reemerged among patients affected by COVID-19 and has become a global concern. The detection of extrasinus involvement in its early stage contributes to improved outcomes; therefore, imaging studies are essential in establishing the degree of involvement and managing the treatment properly, especially in immunocompromised patients. The common sites of extrasinus fungal invasion are the intraorbital, cavernous sinus, and intracranial regions. Fungi spread directly to these regions along the blood vessels or nerves, causing devastating complications such as optic nerve ischemia or compression, optic neuritis or perineuritis, orbital cellulitis, cavernous sinus thrombosis, mycotic aneurysm, vasculitis, internal carotid arterial occlusion, cerebral infarction, cerebritis, and brain abscess. IFRS has a broad imaging spectrum, and familiarity with intra- and extrasinonasal imaging features, such as loss of contrast enhancement of the affected region, which indicates tissue ischemia due to angioinvasion of fungi, and the surrounding anatomy is essential for prompt diagnosis and management. The authors summarize the epidemiology, etiology, risk factors, and complications of IFRS and review the anatomy and key diagnostic imaging features of IFRS beyond the sinonasal regions. ©RSNA, 2022.
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Affiliation(s)
- Mariko Kurokawa
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - Ryo Kurokawa
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - Akira Baba
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - John Kim
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - Christopher Tournade
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - Jonathan Mchugh
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - Jonathan D Trobe
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - Ashok Srinivasan
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - Jayapalli Rajiv Bapuraj
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
| | - Toshio Moritani
- From the Division of Neuroradiology, Department of Radiology (M.K., R.K., A.B., J.K., C.T., A.S., J.R.B., T.M.), Department of Pathology, Michigan Medicine (J.M.), and Kellogg Eye Center, Department of Ophthalmology and Visual Sciences and Department of Neurology (J.D.T.), University of Michigan, 1500 E Medical Center Dr, UH B2, Ann Arbor, MI 48109; and Department of Radiology, Graduate School of Medicine, University of Tokyo, Tokyo, Japan (R.K.)
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Pyrites: An Orbital Mass. J Pediatr Hematol Oncol 2022; 44:65-66. [PMID: 34935736 DOI: 10.1097/mph.0000000000002365] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Accepted: 10/20/2021] [Indexed: 11/26/2022]
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7
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Ghodasara S, Balasubramanian R, Dhiwakar M, varadharajan S, Sundaramoorthy V, Kumar V. Skull base aspergilloma mimicking meningioma in immunocompetent patient. INTERDISCIPLINARY NEUROSURGERY 2021. [DOI: 10.1016/j.inat.2021.101159] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
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8
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Invasive sinus aspergillosis with mycotic aneurysm of the vertebral artery and subarachnoid hemorrhage - Case report. Radiol Case Rep 2021; 16:2651-2657. [PMID: 34336072 PMCID: PMC8318899 DOI: 10.1016/j.radcr.2021.06.041] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 06/15/2021] [Accepted: 06/16/2021] [Indexed: 11/21/2022] Open
Abstract
Invasive sinus aspergillosis is a rare life-threatening condition usually found in immunocompromised patients. The fungus spreads from paranasal sinuses into the central nervous system by direct extension or through blood vessels. Perineural spread is an uncommon mechanism of spread in invasive aspergillosis. A mycotic aneurysm is a dangerous complication of invasive sinus aspergillosis because of its insidious development and is often diagnosed only post-mortem after causing fatal intracranial hemorrhage. Intracranial vascular complications of invasive sinus aspergillosis require prompt recognition and treatment and should always be considered when a diagnosis of CNS aspergillosis is made. We present a case of invasive sinus aspergillosis in an apparently immunocompetent patient that manifested with a brain abscess, perineural spread of the infection, and mycotic aneurysm of the vertebral artery with subsequent rupture and fatal subarachnoid hemorrhage. This case highlights the possibility of perineural spread and hemorrhagic complications in invasive cerebral aspergillosis.
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9
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Can imaging suggest the aetiology in skull base osteomyelitis? A systematic literature review. Pol J Radiol 2021; 86:e309-e321. [PMID: 34136049 PMCID: PMC8186306 DOI: 10.5114/pjr.2021.106470] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/15/2020] [Indexed: 12/27/2022] Open
Abstract
Purpose To assess differentiating features between bacterial, Aspergillus, and Mucor skull base osteomyelitis (SBO) with regard to clinical presentation and imaging appearances. Material and methods A literature search was performed in April 2020 for studies on SBO with a minimum sample size of 10 patients. Studies that reported presenting symptoms, cross-sectional imaging findings, complications, and mortality were included in the analysis. The quality of included articles was tested using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. A data extraction form was used to retrieve relevant parameters from each of the articles. Results Thirteen articles were included in the final analysis. Diabetes mellitus was the most common predisposing factor (12.5-91.0%). Presenting complaints in all bacterial SBO studies were otogenic, while fungal SBO patients had nasal/ocular complaints. Rates of mortality and surgical intervention in the fungal group were 50-100% and 50%, respectively, as compared to the bacterial group – 7-87% and 10%, respectively. On imaging, the site of initial infection in bacterial SBO was the external auditory canal, while in fungal SBO it was the paranasal sinus. The incidence of orbital extension was < 5% in bacterial and 44-70% in fungal SBO, among which Mucor had rates of 65-70%. Bone erosion was less extensive in bacterial SBO, and the patterns differed. The highest incidence of vascular involvement and non-enhancing lesions (23-36%) was seen in Mucor. Aspergillus showed highest sino-cranial extension (52-55%) and homogenous bright enhancement. Conclusions Systematic analysis of the clinico-radiological parameters in each of the studies revealed differences in presentation, clinical course, extension, bone erosion, and enhancement.
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Ahamefule CS, Ezeuduji BC, Ogbonna JC, Moneke AN, Ike AC, Wang B, Jin C, Fang W. Marine Bioactive Compounds against Aspergillus fumigatus: Challenges and Future Prospects. Antibiotics (Basel) 2020; 9:antibiotics9110813. [PMID: 33207554 PMCID: PMC7698247 DOI: 10.3390/antibiotics9110813] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 12/11/2022] Open
Abstract
With the mortality rate of invasive aspergillosis caused by Aspergillus fumigatus reaching almost 100% among some groups of patients, and with the rapidly increasing resistance of A. fumigatus to available antifungal drugs, new antifungal agents have never been more desirable than now. Numerous bioactive compounds were isolated and characterized from marine resources. However, only a few exhibited a potent activity against A. fumigatus when compared to the multitude that did against some other pathogens. Here, we review the marine bioactive compounds that display a bioactivity against A. fumigatus. The challenges hampering the discovery of antifungal agents from this rich habitat are also critically analyzed. Further, we propose strategies that could speed up an efficient discovery and broaden the dimensions of screening in order to obtain promising in vivo antifungal agents with new modes of action.
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Affiliation(s)
- Chukwuemeka Samson Ahamefule
- National Engineering Research Center for Non-Food Biorefinery, Guangxi Academy of Sciences, Nanning 530007, Guangxi, China; (C.S.A.); (B.W.)
- College of Life Science and Technology, Guangxi University, Nanning 530005, Guangxi, China
- Department of Microbiology, University of Nigeria, Nsukka 410001, Enugu State, Nigeria; (J.C.O.); (A.N.M.); (A.C.I.)
| | | | - James C. Ogbonna
- Department of Microbiology, University of Nigeria, Nsukka 410001, Enugu State, Nigeria; (J.C.O.); (A.N.M.); (A.C.I.)
| | - Anene N. Moneke
- Department of Microbiology, University of Nigeria, Nsukka 410001, Enugu State, Nigeria; (J.C.O.); (A.N.M.); (A.C.I.)
| | - Anthony C. Ike
- Department of Microbiology, University of Nigeria, Nsukka 410001, Enugu State, Nigeria; (J.C.O.); (A.N.M.); (A.C.I.)
| | - Bin Wang
- National Engineering Research Center for Non-Food Biorefinery, Guangxi Academy of Sciences, Nanning 530007, Guangxi, China; (C.S.A.); (B.W.)
- State Key Laboratory of Non-food Biomass and Enzyme Technology, Guangxi Academy of Sciences, Nanning 530007, Guangxi, China
| | - Cheng Jin
- National Engineering Research Center for Non-Food Biorefinery, Guangxi Academy of Sciences, Nanning 530007, Guangxi, China; (C.S.A.); (B.W.)
- College of Life Science and Technology, Guangxi University, Nanning 530005, Guangxi, China
- Correspondence: (C.J.); (W.F.)
| | - Wenxia Fang
- National Engineering Research Center for Non-Food Biorefinery, Guangxi Academy of Sciences, Nanning 530007, Guangxi, China; (C.S.A.); (B.W.)
- State Key Laboratory of Non-food Biomass and Enzyme Technology, Guangxi Academy of Sciences, Nanning 530007, Guangxi, China
- Correspondence: (C.J.); (W.F.)
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Sharma R, Garg K, Phalak M, Tandon V, Kumari K, Suri V, Suri A, Garg A, Kale SS, Mahapatra AK. Aspergilloma Masquerading as Meningioma: An Experience of Two Cases and Review of Literature. Neurol India 2019; 67:1133-1136. [PMID: 31512657 DOI: 10.4103/0028-3886.266244] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Ravi Sharma
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kanwaljeet Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Manoj Phalak
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vivek Tandon
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Kalpana Kumari
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Vaishali Suri
- Department of Pathology, All India Institute of Medical Sciences, New Delhi, India
| | - Ashish Suri
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - Ajay Garg
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
| | - S S Kale
- Department of Neuroradiology, All India Institute of Medical Sciences, New Delhi, India
| | - A K Mahapatra
- Department of Neurosurgery, All India Institute of Medical Sciences, New Delhi, India
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El Hasbani G, Chirayil J, Nithisoontorn S, Antezana AA, El Husseini I, Landaeta M, Saeed Y, Assaker R. Cerebral aspergillosis presenting as a space occupying lesion in an immunocompetent individual. Med Mycol Case Rep 2019; 25:45-48. [PMID: 31453078 PMCID: PMC6700407 DOI: 10.1016/j.mmcr.2019.07.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/06/2019] [Accepted: 07/31/2019] [Indexed: 11/11/2022] Open
Abstract
Cerebral aspergillosis has the tendency to occur in immunocompromised patients. Less commonly, immunocompetent individuals can be affected, with neuroimaging findings being difficult to interpret. The diagnosis necessitates imaging of the brain as well as the sinuses with biopsy and pathological confirmation. A surgical excision with aggressive antifungal agents are required for a proper management. This case report describes an immunocompetent patient with cerebral aspergillosis that presented radiologically as a suspicious mass to be diagnosed pathologically and excised surgically.
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Affiliation(s)
| | - Joseph Chirayil
- Lincoln Medical and Mental Health Center, Bronx, New York, USA
| | | | | | | | - Maria Landaeta
- Lincoln Medical and Mental Health Center, Bronx, New York, USA
| | - Yasir Saeed
- Lincoln Medical and Mental Health Center, Bronx, New York, USA
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Mishra A, Prabhuraj AR, Shukla DP, Nandeesh BN, Chandrashekar N, Ramalingaiah A, Arivazhagan A, Bhat DI, Somanna S, Devi BI. Intracranial fungal granuloma: a single-institute study of 90 cases over 18 years. Neurosurg Focus 2019; 47:E14. [PMID: 31370017 DOI: 10.3171/2019.5.focus19252] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2019] [Accepted: 05/10/2019] [Indexed: 12/12/2022]
Abstract
OBJECTIVE Intracranial fungal granuloma (IFG) remains an uncommon entity. The authors report a single-institute study of 90 cases of IFG, which is the largest study until now. METHODS In this retrospective study, all cases of IFG surgically treated in the years 2001-2018 were included. Data were obtained from the medical records and the pathology, microbiology, and radiology departments. All relevant clinical data, imaging characteristics, surgical procedure performed, perioperative findings, and follow-up data were recorded from the case files. Telephonic follow-up was also performed for a few patients to find out their current status. RESULTS A total of 90 cases consisting of 64 males (71.1%) and 26 (28.9%) females were evaluated. The mean patient age was 40.2 years (range 1-79 years). Headache (54 patients) was the most common presenting complaint, followed by visual symptoms (35 patients), fever (21 patients), and others such as limb weakness (13 patients) or seizure (9 patients). Cranial nerve involvement was the most common sign (47 patients), followed by motor deficit (22 patients) and papilledema (7 patients). The mean duration of symptoms before presentation was 6.4 months (range 0.06-48 months). Thirty patients (33.3%) had predisposing factors like diabetes mellitus, tuberculosis, or other immunocompromised status. A pure intracranial location of the IFG was seen in 49 cases (54.4%), whereas rhinocerebral or paranasal sinus involvement was seen in 41 cases (45.6%). Open surgery, that is, craniotomy and decompression, was performed in 55 cases, endoscopic biopsy was done in 30 cases, and stereotactic biopsy was performed in 5 cases. Aspergilloma (43 patients) was the most common fungal mass, followed by zygomycosis (13 patients), chromomycosis (9 patients), cryptococcoma (7 patients), mucormycosis (5 patients), and candida infection (1 patient). In 12 cases, the exact fungal phenotype could not be identified. Follow-up was available for 69/90 patients (76.7%). The mean duration of the follow-up was 37.97 months (range 3-144 months). The mortality rate was 52.2% (36/69 patients) among the patients with available follow-up. CONCLUSIONS A high index of suspicion for IFG should exist for patients with an immunocompromised status and diabetic patients with rhinocerebral mass lesions. Early diagnosis, aggressive surgical decompression, and a course of promptly initiated antifungal therapy are associated with a better prognosis.
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Affiliation(s)
| | | | | | | | | | - Arvinda Ramalingaiah
- 4Neuroimaging and Interventional Radiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
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Chang YM, Chang YH, Chien KH, Liang CM, Tai MC, Nieh S, Chen YJ. Orbital apex syndrome secondary to aspergilloma masquerading as a paranasal sinus tumor: A case report and literature review. Medicine (Baltimore) 2018; 97:e11650. [PMID: 30045315 PMCID: PMC6078660 DOI: 10.1097/md.0000000000011650] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022] Open
Abstract
RATIONALE Orbital apex syndrome is a complex clinical disorder featuring a collection of cranial nerve deficits characterized by impairment of the extraocular muscles, the ophthalmic branch of the trigeminal nerve, and even the optic nerve. Sino-orbital aspergillosis is rare but aggressive infection. Surgical resection accompanied by antifungal medication is advised currently. PATIENT CONCERNS We report a 61-year-old woman diagnosed as aspergilloma presenting with the characteristic manifestations and imaging features of orbital apex syndrome. DIAGNOSES Paranasal sinus tumor was misdiagnosed initially according to magnetic resonance imaging of the orbit. Finally aspergilloma was diagnosed by pathologic report. INTERVENTIONS The anti-fungal medication, voriconazole, was administered immediately. Surgical excision was also done due to the poor response to medical treatment. OUTCOMES Postoperative follow-up showed no recurrence of aspergillosis but the vision was lost permanently. LESSONS Invasive sino-orbital aspergillosis as an aggressive disease with highly invasive patterns and it may be misdiagnosed as tumors. To achieve better prognosis and survival, clinicians should be aware of this distinct manifestation.
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Affiliation(s)
| | | | | | | | | | - Shin Nieh
- Department of Pathology, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
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15
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Primary Aspergillosis of the Sphenoid Sinus Observed on Bone SPECT/CT. Clin Nucl Med 2018; 43:141-143. [PMID: 29261632 DOI: 10.1097/rlu.0000000000001957] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The bone SPECT/CT allows for precise anatomic delineation of bone activity, which can be valuable for diagnosis of nonmalignant bone diseases. We report an extremely rare case of sphenoid sinus aspergillosis, observed on bone SPECT/CT imaging, as an isolated disease in an immunocompetent individual. A 58-year-old woman with a history of plantar fasciitis was assessed for infection in the tarsal bones. Planar bone scan image revealed incidental focal lesion in skull base, which was considered to be the left sphenoid sinusitis by the bone SPECT/CT scan.
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16
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Kumar D, Nepal P, Singh S, Ramanathan S, Khanna M, Sheoran R, Bansal SK, Patil S. CNS aspergilloma mimicking tumors: Review of CNS aspergillus infection imaging characteristics in the immunocompetent population. J Neuroradiol 2018; 45:169-176. [DOI: 10.1016/j.neurad.2017.11.001] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Revised: 09/24/2017] [Accepted: 11/28/2017] [Indexed: 11/29/2022]
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17
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Progress in the treatment of fungal infections of the central nervous system. INFECTION INTERNATIONAL 2018. [DOI: 10.1515/ii-2017-0161] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Abstract
The incidence of fungal infections of the central nervous system (CNS) has gradually increased in recent years. Intracranial fungal infection can be classified as diffuse and focal infections. The clinical manifestations of these infections include fever and cranial pressure caused by meningitis or meningoencephalitis, as well as focal neurological defects caused by lesions in the intracranial space. Diagnosing fungal infections of the CNS requires comprehensive analysis of the patient’s medical history, epidemiology, underlying disease, clinical manifestation, imaging manifestations, and results from various laboratory tests. The identification of fungal bodies or structures in brain tissue or cerebrospinal fluid specimens is the golden standard of diagnosis. The principles for the treatment of fungal infections of the CNS are the effective control of pathogenic risk factors, use of effective antifungal drugs, and the active implementation of surgical intervention for fungal abscesses and granulomas. In the meantime, new diagnoses and treatments should be actively explored to improve the prognosis of patients.
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18
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Soni N, Gupta N, Kumar Y, Mangla M, Mangla R. Role of diffusion-weighted imaging in skull base lesions: A pictorial review. Neuroradiol J 2017. [PMID: 28631996 DOI: 10.1177/1971400917709624] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Skull base lesions can be related to wide number of pathologies including infections, benign and malignant tumors. Accurate diagnosis and differentiation between these entities is important for prompt and appropriate treatment. However, computed tomography and routine magnetic resonance imaging techniques only provide information on the extent of the lesions, with limited ability to differentiate between benign and malignant lesions. Diffusion-weighted imaging can help in many such situations by providing additional information, including help in differentiating benign from malignant lesions, so that appropriate treatment can be initiated. In this review article, we illustrate the imaging findings of the spectrum of skull base lesions, emphasizing the role of diffusion-weighted imaging in this domain.
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Affiliation(s)
- Neetu Soni
- 1 Department of Radiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, India
| | - Nishant Gupta
- 2 Department of Radiology, St Vincent's Medical Center, Bridgeport, USA
| | - Yogesh Kumar
- 3 Department of Radiology, Yale New Haven Health at Bridgeport Hospital, Bridgeport, USA
| | | | - Rajiv Mangla
- 5 Department of Radiology, SUNY Upstate Medical University, Syracuse, NY, USA
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19
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Naval Baudin P, Pons Escoda A, Cos Domingo M, Huete Naval M, Majós C, Aguilera C. Invasive Sinonasal Lesions: From the Nasal Fossa and Paranasal Sinuses to the Endocranium. Curr Probl Diagn Radiol 2017; 47:168-178. [PMID: 28550940 DOI: 10.1067/j.cpradiol.2017.04.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Revised: 03/27/2017] [Accepted: 04/06/2017] [Indexed: 11/22/2022]
Abstract
The aim of this work is to review the spectrum of sinonasal lesions that extend to the endocranium and to present key points that may narrow the differential diagnosis. The most frequent sinonasal lesions that extend into the endocranium are malignant; however, benign entities are not unusual. Imaging diagnosis is difficult because malignant lesions and benign entities share similar clinical, epidemiologic, and imaging features. Tumor features in relation to bone, intratumor homogeneity and structure, magnetic resonance imaging signal, along with clinical and epidemiologic aspects may allow an appropriate diagnostic focus with important management implications.
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Affiliation(s)
- Pablo Naval Baudin
- Department of Radiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Albert Pons Escoda
- Institut de Diagnòstic per la Imatge IDI, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Mònica Cos Domingo
- Institut de Diagnòstic per la Imatge IDI, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Mario Huete Naval
- Department of Radiology, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carles Majós
- Institut de Diagnòstic per la Imatge IDI, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Carles Aguilera
- Institut de Diagnòstic per la Imatge IDI, Hospital Universitari de Bellvitge, L'Hospitalet de Llobregat, Barcelona, Spain
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20
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Roy B, Grosberg BM. Teaching Images in Headache: Cavernous Sinus Aspergillosis. Headache 2016; 56:1653-1655. [DOI: 10.1111/head.12964] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Revised: 07/11/2016] [Accepted: 07/12/2016] [Indexed: 11/28/2022]
Affiliation(s)
- Bhaskar Roy
- Department of Neurology; University of Connecticut School of Medicine; CT USA
- Hartford Healthcare Headache Center; CT USA
| | - Brian M. Grosberg
- Department of Neurology; University of Connecticut School of Medicine; CT USA
- Hartford Healthcare Headache Center; CT USA
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21
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Shah SR, Keshri A, Patadia S, Marak RSK, Behari S. Invasive Aspergillosis of Anterior Skull Base in the Immunocompetent Host: Outcomes with a Combined Treatment Modality-An Institutional Experience. J Neurol Surg B Skull Base 2016; 78:89-95. [PMID: 28180049 DOI: 10.1055/s-0036-1585089] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2016] [Accepted: 05/27/2016] [Indexed: 10/21/2022] Open
Abstract
Objectives To study outcomes with voriconazole therapy in immunocompetent individuals following maximal safe endoscopic resection in invasive aspergillosis of the anterior skull base. Design Retrospective study of patients with chronic invasive aspergillosis including symptomatology, extent of disease, and response to voriconazole following maximal safe resection in immunocompetent individuals. Setting Tertiary care superspeciality referral center. Participants Ten consecutive patients of invasive aspergillosis of anterior skull base managed over a period of 2 years. Main Outcome Measures Symptom resolution with systemic voriconazole and radiologic evaluation following systemic antifungals as per predefined protocol. Conclusions Maximal safe resection via transnasal endoscopic route followed by systemic antifungals provides excellent outcomes in invasive skull base aspergillosis. Although liver and renal functions, besides visual acuity, need serial monitoring, voriconazole is well tolerated by our patients.
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Affiliation(s)
- Saurin R Shah
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Amit Keshri
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Simple Patadia
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Rungmei S K Marak
- Department of Microbiology, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Sanjay Behari
- Department of Neurosurgery, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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22
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Patterson TF, Thompson GR, Denning DW, Fishman JA, Hadley S, Herbrecht R, Kontoyiannis DP, Marr KA, Morrison VA, Nguyen MH, Segal BH, Steinbach WJ, Stevens DA, Walsh TJ, Wingard JR, Young JAH, Bennett JE. Practice Guidelines for the Diagnosis and Management of Aspergillosis: 2016 Update by the Infectious Diseases Society of America. Clin Infect Dis 2016; 63:e1-e60. [PMID: 27365388 DOI: 10.1093/cid/ciw326] [Citation(s) in RCA: 1591] [Impact Index Per Article: 198.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2016] [Accepted: 05/11/2016] [Indexed: 12/12/2022] Open
Abstract
It is important to realize that guidelines cannot always account for individual variation among patients. They are not intended to supplant physician judgment with respect to particular patients or special clinical situations. IDSA considers adherence to these guidelines to be voluntary, with the ultimate determination regarding their application to be made by the physician in the light of each patient's individual circumstances.
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Affiliation(s)
- Thomas F Patterson
- University of Texas Health Science Center at San Antonio and South Texas Veterans Health Care System
| | | | - David W Denning
- National Aspergillosis Centre, University Hospital of South Manchester, University of Manchester, United Kingdom
| | - Jay A Fishman
- Massachusetts General Hospital and Harvard Medical School
| | | | | | | | - Kieren A Marr
- Johns Hopkins University School of Medicine and the Sidney Kimmel Comprehensive Cancer Center, Baltimore, Maryland
| | - Vicki A Morrison
- Hennepin County Medical Center and University of Minnesota, Minneapolis
| | | | - Brahm H Segal
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, and Roswell Park Cancer Institute, New York
| | | | | | - Thomas J Walsh
- New York-Presbyterian Hospital/Weill Cornell Medical Center, New York
| | | | | | - John E Bennett
- Laboratory of Clinical Infectious Diseases, National Institute of Allergy and Infectious Disease, National Institutes of Health, Bethesda, Maryland
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23
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Vergara GE, Roura N, Del Castillo M, Mora A, Alcorta SC, Mormandi R, Cervio A, Salvat J. [Cervical aspergillosis with dissemination to the central nervous system: Case reports and review of the literature]. Surg Neurol Int 2015; 6:S524-9. [PMID: 26600985 PMCID: PMC4623611 DOI: 10.4103/2152-7806.167203] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 03/19/2015] [Indexed: 10/25/2022] Open
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. CASE DESCRIPTION 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. CONCLUSION 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.
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Affiliation(s)
| | - Natalia Roura
- Traumatólogos (Neurortopedistas) del Departamento de Neurocirugía de FLENI, Buenos Aires, Argentina
| | | | - Andrea Mora
- Infectólogos del Departamento de Infectología de FLENI, Buenos Aires, Argentina
| | | | - Rubén Mormandi
- Neurocirujanos del Departamento de Neurocirugía de FLENI, Buenos Aires, Argentina
| | - Andrés Cervio
- Neurocirujanos del Departamento de Neurocirugía de FLENI, Buenos Aires, Argentina
| | - Jorge Salvat
- Neurocirujanos del Departamento de Neurocirugía de FLENI, Buenos Aires, Argentina
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24
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25
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Intracranial Fungal Granulomas: A Single Institutional Clinicopathologic Study of 66 Patients and Review of the Literature. World Neurosurg 2015; 83:1166-72. [DOI: 10.1016/j.wneu.2015.01.053] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2014] [Revised: 01/22/2015] [Accepted: 01/28/2015] [Indexed: 11/22/2022]
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26
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Fukui I, Hayashi Y, Kita D, Nakanishi S, Tachibana O. Aspergillus Sphenoiditis Associated with an Artificial Bone Graft Used for Transsphenoidal Surgery. NMC Case Rep J 2015; 2:68-71. [PMID: 28663968 PMCID: PMC5364913 DOI: 10.2176/nmccrj.2014-0187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2014] [Accepted: 10/28/2014] [Indexed: 11/23/2022] Open
Abstract
Cerebrospinal fluid (CSF) leakage is a major complication during and after transsphenoidal surgery (TSS) for intra- and suprasellar tumors. To prevent postoperative CSF leakage, various surgical techniques have been used, including sellar floor reconstruction with artificial bone grafts. However, some authors have recently reported infections associated with artificial bone grafts. Most cases are associated with bacterial infection, and fungal infection is extremely rare. We present the case of a 53-year-old woman with sphenoiditis caused by Aspergillus infection that developed 8 years after TSS and following local radiation therapy for a non-functioning pituitary adenoma. An artificial bone graft prepared from polymethylmethacrylate was used for sellar floor reconstruction. The patient presented to our department with a complaint of bloody nasal discharge. Magnetic resonance imaging showed that a fungal lump had formed around the bone graft, which had broken into two pieces and dropped out into the sphenoid sinus, without tumor recurrence. Histological examination of an endoscopic biopsy specimen led to a diagnosis of aspergillosis. Subsequent complete removal of both the bone graft and fungal lump resulted in a good postoperative outcome. Although fungal infection is an extremely rare complication after TSS using artificial bone grafts, it should be diagnosed as early as possible, and removal of both the fungal lump and the bone graft should be performed in a timely manner after clinical and radiological confirmation.
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Affiliation(s)
- Issei Fukui
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa
| | - Yasuhiko Hayashi
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa
| | - Daisuke Kita
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa
| | - Sayaka Nakanishi
- Department of Otolaryngology, Graduate School of Medical Science, Kanazawa University, Kanazawa, Ishikawa
| | - Osamu Tachibana
- Department of Neurosurgery, Kanazawa Medical University, Kanazawa, Ishikawa
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27
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Fukui I, Hayashi Y, Kita D, Nakanishi S, Tachibana O. Aspergillus Sphenoiditis Associated with an Artificial Bone Graft Used for Transsphenoidal Surgery. NMC Case Rep J 2015. [DOI: 10.2176/nmccrj.cr.2014-0187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Affiliation(s)
- Issei Fukui
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University
| | - Yasuhiko Hayashi
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University
| | - Daisuke Kita
- Department of Neurosurgery, Graduate School of Medical Science, Kanazawa University
| | - Sayaka Nakanishi
- Department of Otolaryngology, Graduate School of Medical Science, Kanazawa University
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28
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Isolated Cerebral Aspergillosis in Immunocompetent Patients. World Neurosurg 2014; 82:e325-33. [DOI: 10.1016/j.wneu.2013.09.037] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2013] [Accepted: 09/18/2013] [Indexed: 12/17/2022]
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Abstract
The epidemiology of invasive fungal infections in immunocompromised patients is rapidly changing. Several of the fungi have worldwide distribution. However, some have specific geographical distribution. Sinocranial aspergillosis, mostly described from countries with temperate climates, occurs mostly in otherwise immunocompetent individuals Most of the systemic fungal pathogens have been associated with central nervous system (CNS) involvement. The major advances in CNS fungal infections are in the pathobiology, new diagnostic tools, and new therapies. In spite of these developments, there is still considerable delay in the diagnosis of CNS fungal infection. CNS fungal infections are associated with considerable morbidity and mortality. To achieve good outcomes early diagnosis and early institution of appropriate therapies are the key issues.
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Affiliation(s)
- J M K Murthy
- Continental Institute of Neurosciences & Rehabilitation, Continental Hospitals, IT & Financial District, Gachibowli, Hyderabad, India.
| | - C Sundaram
- Department of Pathology, Nizam's Institute of Medical Sciences, Panjagutta, Hyderabad, India
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30
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Image features of aspergillosis arising from the pterygopalatine fossa: a case report and literature review. Oral Radiol 2013. [DOI: 10.1007/s11282-013-0159-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
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Ahmadzai H, Raley DA, Masters L, Davies M. An unusual case of a pituitary fossa aspergilloma in an immunocompetent patient mimicking infiltrative tumour. J Surg Case Rep 2013; 2013:rjt018. [PMID: 24964429 PMCID: PMC3635217 DOI: 10.1093/jscr/rjt018] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Sellar aspergillosis is a rare infection commonly mistaken for a pituitary tumour. We present a rare case of pituitary fossa Aspergillus fumigatus mycetoma in an immunocompetent 90-year-old female, who presented with headaches. Magnetic resonance imaging scans demonstrated an enhancing pituitary fossa mass that appeared to infiltrate the sphenoid sinus, suggestive of an invasive tumour. Stereotactic trans-sphenoidal resection confirmed localized A. fumigatus infection. The abscess was debrided and the dura was left intact. Her headaches resolved post-operatively and she was treated with voriconazole. This indicates that aspergilloma should be considered as a differential for an unexplained pituitary lesion even in elderly immunocompetent patients.
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Affiliation(s)
- Hasib Ahmadzai
- Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia Department of Neurology and Neurosurgery, St George Hospital, Kogarah, Australia
| | - Darryl Alan Raley
- Department of Neurology and Neurosurgery, St George Hospital, Kogarah, Australia
| | - Lynette Masters
- Department of Neuroradiology, Southern Radiology, Miranda, Australia Brain and Mind Research Institute, University of Sydney, Camperdown, Australia
| | - Mark Davies
- Faculty of Medicine, University of New South Wales (UNSW), Sydney, Australia Department of Neurology and Neurosurgery, St George Hospital, Kogarah, Australia
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Ali H, Lui NL, Salkade PR, Mohan PC, Lingegowda PB, Tan YK. Orbital Aspergillosis or Giant Cell Arteritis — A Diagnostic Dilemma. PROCEEDINGS OF SINGAPORE HEALTHCARE 2013. [DOI: 10.1177/201010581302200112] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
- Hassan Ali
- Department of Rheumatology and Immunology, Singapore General Hospital
| | - Nai Lee Lui
- Department of Rheumatology and Immunology, Singapore General Hospital
- Duke-NUS Graduate Medical School, Singapore
| | | | | | | | - York Kiat Tan
- Department of Rheumatology and Immunology, Singapore General Hospital
- Duke-NUS Graduate Medical School, Singapore
- Yong Loo Lin School of Medicine, National University of Singapore
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Verma R, Singh P, Kumar A, Paliwal VK. Cranial aspergilloma masquerading as meningioma. BMJ Case Rep 2013; 2013:bcr-2012-008118. [PMID: 23307467 DOI: 10.1136/bcr-2012-008118] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Cranial aspergillosis may present as meningitis, cerebral abscess, cerebral infarcts/haemorrhages or extra-axial mass. Extra-axial cranial aspergilloma may mimic meningioma owing to mass-like characteristics and intense contrast enhancement on MRI there by delaying the diagnosis and further worsening the already bad prognosis in these patients. We present a 45-year-old gentleman who presented with signs of raised intracranial hypertension, secondary optic atrophy and a contrast-enhancing mass arising from the planum sphenoidale. Postoperatively, mass was diagnosed as aspergilloma on histopathology and culture. Despite antifungal treatment, patient could not be saved due to large artery infarcts in the immediate postoperative period. We discuss the clinical and MRI features that could help to have sufficient and early suspicion of fungal aetiology in these patients.
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Affiliation(s)
- Ritu Verma
- Department of Pathology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Abstract
Invasive aspergillosis has been classically associated with certain risk factors: cytotoxic chemotherapy, prolonged neutropenia, corticosteroids, transplantation, AIDS. However, the literature is growing that this mycosis, particularly pulmonary aspergillosis, can be seen in patients lacking these factors. Many of the latter patients are in the intensive care unit. Other associated conditions include influenza, nonfungal pneumonia, chronic obstructive lung disease, immaturity, sepsis, liver failure, alcoholism, chronic granulomatous disease and surgery. Certain focal sites, such as sinusitis or cerebral aspergillosis, have additional risk factors. This emphasizes the potential importance of a positive culture for Aspergillus in the critically ill, the need for awareness about possible aspergillosis in patients lacking the classical risk factors, and readiness to proceed with appropriate diagnostic maneuvers.
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Affiliation(s)
- David A Stevens
- Department of Medicine, Santa Clara Valley Medical Center, 751 So. Bascom Ave., San Jose, CA 95128-2699, USA.
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Unusual presentation of neurobrucellosis: a solitary intracranial mass lesion mimicking a cerebral tumor : a case of encephalitis caused by Brucella melitensis. J Infect Chemother 2012; 18:767-70. [PMID: 22231602 PMCID: PMC3491191 DOI: 10.1007/s10156-011-0365-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2011] [Accepted: 12/25/2011] [Indexed: 10/26/2022]
Abstract
Among the diverse presentations of neurobrucellosis, solitary intracranial mass lesions are extremely rare. To the best of our knowledge, we describe here the second case of neurobrucellosis mimicking a cerebral tumor caused by Brucella melitensis. The mass lesion was clinically and radiologically indistinguishable from a brain tumor. The diagnosis was established by isolating Brucella melitensis in a blood culture and a positive Wright's agglutination test on the cerebrospinal fluid at 1:320 titers. Paraffin sections of the cerebral mass showed nongranulomatous encephalitis. We suggest that patients with an isolated intraparenchymal mass lesion with nongranulomatous encephalitis should also be studied for brucellosis in endemic areas.
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Ederies A, Chen J, Aviv RI, Pirouzmand F, Bilbao JM, Thompson AL, Symons SP. Aspergillosis of the Petrous Apex and Meckel's Cave. Skull Base 2011; 20:189-92. [PMID: 21318037 DOI: 10.1055/s-0029-1246229] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
Cranial cerebral aspergillosis is a rare entity in immunocompetent patients. Invasive disease involving the petrous apex and Meckel's cave has rarely been described. We present a case of localized invasive petrous apical and Meckel's cave disease in an immunocompetent patient who presented with hemicranial neuralgic pain.
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Affiliation(s)
- Ash Ederies
- Division of Neuroradiology, Department of Medical Imaging, Sunnybrook Health Sciences Centre, University of Toronto, Toronto, Ontario, Canada
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Imaging findings in intracranial aspergillus infection in immunocompetent patients. World Neurosurg 2011; 74:661-70. [PMID: 21492637 DOI: 10.1016/j.wneu.2010.06.017] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Accepted: 06/02/2010] [Indexed: 12/11/2022]
Abstract
AIM To study the neuroimaging features of craniocerebral aspergillosis infection in immunocompetent patients. MATERIALS AND METHODS The clinical and imaging data of 12 patients of aspergillus fungal infection were retrospectively reviewed. Diagnosis of fungal infection was confirmed by histopathologic examination of surgically excised specimen, stereotactic biopsy material, or endoscopic sinus biopsy. The radiologic studies were evaluated for anatomic distribution of lesions, signal intensity, contrast enhancement, presence of hemorrhage, diffusion restriction, perfusion, and spectroscopy characteristics. Medical records, biopsy reports, and autopsy findings were also reviewed. RESULTS Twelve cases of aspergillosis infections in immunocompetent patients were diagnosed at our hospital over a period of 10 years. Lesions could be classified based on imaging of lesions of sinonasal origin, intracranial mass lesion including both parenchymal or extraparenchymal meningeal based and stroke. Coexisting meningitis was also noted in one patient. Disease of sinonasal origin commonly showed invasion of the cavernous sinus and orbital apex resulting in visual symptoms and multiple cranial nerve palsies. Intracranial mass lesions without sinonasal involvement were seen in five cases that included isolated parenchymal lesion in two patients and dural-based mass lesions in three patients. Isolated intraparenchymal lesions included two cases of fungal cerebritis. Dural-based lesions were large granulomas with a significant mass effect. Infarcts were seen in three patients and angiography showed vessel narrowing or occlusion in all the three patients. CT demonstrated isodense to hyperdense attenuation of primary sinus disease with evidence of bone destruction in all the cases of sinonasal origin. Primary parenchymal lesions showed heterogenous attenuation with predominantly low-density areas. Dural-based lesions showed isodense to hyperdense attenuation. Magnetic resonance imaging revealed isointense to hypointense signal intensity on both T(1)-weighted (T1W) and T(2)-weighted (T2W) images in all lesions of sinonasal origin and isolated dural-based mass lesions. Primary parenchymal lesions showed heterogenous signal intensity pattern with predominantly hypointense signal on T1W and hyperintense signal on T2W images. Diffusion weighted imaging, magnetic resonance spectroscopy, and perfusion-weighted imaging gave valuable ancillary information in these cases. CONCLUSION Sinonasal disease with intracranial extension is the commonest pattern of aspergillus infection followed by intracranial mass lesions. Hyperdense sinonasal disease with bone destruction and intracranial extension on computed tomography, hypointense signal intensity of the lesions on T2W magnetic resonance images, presence of areas of restricted diffusion, decreased perfusion on perfusion-weighted imaging, and presence of hemorrhages are key to the imaging diagnosis of fungal infection.
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A case of invasive paranasal aspergillosis that developed from a non-invasive form during 5-year follow-up. Auris Nasus Larynx 2010; 37:250-4. [DOI: 10.1016/j.anl.2009.06.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2008] [Revised: 05/19/2009] [Accepted: 06/08/2009] [Indexed: 11/21/2022]
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Orbital aspergillus infection mimicking a tumour: a case report. CASES JOURNAL 2009; 2:7860. [PMID: 19918490 PMCID: PMC2769380 DOI: 10.4076/1757-1626-2-7860] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/12/2009] [Accepted: 08/24/2009] [Indexed: 11/21/2022]
Abstract
A 14-year-old male presented to the neurosurgical clinic with swelling just above the right eye which had been growing slowly for the last eight years. The swelling first appeared following a non-penetrating trauma eight years ago. On examination it was a non-tender, non-erythematous, firm, round swelling causing marked proptosis and diplopia on downward gaze only. The visual acuity was intact. MRI showed an intraorbital, extraconal mass isointense on T1 and hypointense on T2 imaging. A diagnosis of orbital tumor was made. A white, friable mass consistent with meningioma was resected. However histopathology report later showed it to be an Aspergilloma. The patient was successfully treated with anti-fungal medicine and was disease-free at one year follow-up.
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Kroot EJA, Demeyere T, van der Linden AN, Visser C, Traksel RAM. Intracranial aspergilloma in a patient with rheumatoid arthritis. Scand J Rheumatol 2009; 37:233-4. [DOI: 10.1080/03009740701867356] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Sugai A, Oyake M, Umeda M, Umeda Y, Fujita N. [Case of orbital apex syndrome caused by invasive aspergillosis successfully treated during the diagnostic procedure by the use of voriconazole]. Rinsho Shinkeigaku 2009; 48:746-9. [PMID: 19086432 DOI: 10.5692/clinicalneurol.48.746] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
A 75-year-old woman developed loss of vision and decreased ocular motility in all directions. She exhibited a left orbital apex syndrome, accompanied by sphenoiditis and hypertrophic pachymeningitis. Voriconazole treatment was initiated on the basis of clinical suspicion, although use of the serum beta-D glucan had negative results and a biopsy was not performed. Five days later, the left eye movements started to improve, and at that time the use of the serum aspergillus galactomannan antigen proved to have positive results. Six months later, the patient was neurologically intact and stable, except for a lack of visual acuity in counting fingers. Earlier prognoses of invasive sino-orbital aspergillosis were dismal, especially when corticosteroid therapy was done before diagnosis. This case suggests the usefulness of antifungal agents during the diagnostic procedure even when localized invasive aspergillosis is not ruled out.
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Cunliffe CH, Fischer I, Monoky D, Law M, Revercomb C, Elrich S, Kopp MJ, Zagzag D. Intracranial lesions mimicking neoplasms. Arch Pathol Lab Med 2009; 133:101-23. [PMID: 19123722 DOI: 10.5858/133.1.101] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/25/2008] [Indexed: 11/06/2022]
Abstract
CONTEXT A broad spectrum of nonneoplastic conditions can mimic a brain tumor, both clinically and radiologically. In this review we consider these, taking into consideration the following etiologic categories: infection, demyelination, vascular diseases, noninfectious inflammatory disorders, and iatrogenic conditions. We give an overview of such diseases, which represent a potential pitfall for pathologists and other clinicians involved in patient care, and present selected cases from each category. OBJECTIVE To illustrate the radiologic and pathologic features of nontumoral intracranial lesions that can clinically and radiologically mimic neoplasia. DATA SOURCES Case-derived material and literature review. CONCLUSIONS A variety of nonneoplastic lesions can present clinically and radiologically as primary or metastatic central nervous system tumors and result in surgical biopsy or resection of the lesion. In such situations, the pathologist has an important role to play in correctly determining the nature of these lesions. Awareness of the entities that can present in this way will assist the pathologist in the correct diagnosis of these lesions.
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Affiliation(s)
- Clare H Cunliffe
- Department of Pathology, Division of Neuropathology, New York University Medical Center, New York, NY, USA.
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Hiraga A, Uzawa A, Shibuya M, Numata T, Sunami S, Kamitsukasa I. Neuroaspergillosis in an immunocompetent patient successfully treated with voriconazole and a corticosteroid. Intern Med 2009; 48:1225-9. [PMID: 19602790 DOI: 10.2169/internalmedicine.48.2165] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
Aspergillosis of the central nervous system (CNS) is an uncommon infection, mainly occurring in immunocompromised patients. We report a case of nasocerebral aspergillosis in an immunocompetent patient successfully treated with voriconazole and a corticosteroid. Magnetic resonance imaging (MRI) showed contrast enhancement surrounding the brainstem and cerebellum with intramedullary pontine and cerebellar T2-hyperintense lesions. The patient's symptoms and MRI abnormalities improved after voriconazole and corticosteroid treatment; however, discontinuation of the corticosteroid caused a worsening of the T2-hyperintense lesions, whereas resuming it resulted in its improvement. This suggested that these T2-hyperintense lesions may be due to secondary inflammation caused by aspergillosis and not the aspergillosis itself. We conclude that treatment with a combination of voriconazole and a corticosteroid appears to be effective for the treatment of some patients with CNS aspergillosis.
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Turgut M, Ozsunar Y, Oncü S, Akyüz O, Ertuğrul MB, Tekin C, Gültekin B, Sakarya S. Invasive fungal granuloma of the brain caused by Aspergillus fumigatus: a case report and review of the literature. ACTA ACUST UNITED AC 2007; 69:169-74; discussion 174. [PMID: 17825367 DOI: 10.1016/j.surneu.2006.12.049] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2006] [Accepted: 12/06/2006] [Indexed: 11/29/2022]
Abstract
BACKGROUND Involvement of the brain by Aspergillus fumigatus, named as invasive aspergillosis, is extremely rare. Definitive diagnosis needs isolation of the fungus from the tissue specimens and its culture. The disease is very resistant to treatment and quickly becomes fatal despite antifungal chemotherapy with AmB preparations, the drugs of choice for the infection. CASE DESCRIPTION We hereby present a unique case of fungal granuloma of the brain due to A fumigatus, which was cured successfully by intensive antifungal treatment, along with a brief literature review. CONCLUSIONS Although it is rare, we draw the attention to the fact that early diagnostic procedures with rapid confirmation of Aspergillus infection and an early initiation of therapy are pivotal for a benign clinical course in such cases. A complete regression of the disease could be achieved with medical therapy alone with conventional AmB or liposomal AmB combined with oral itraconazole even if a total surgical excision of the lesions could not be performed in complicated cases, as in our patient.
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Affiliation(s)
- Mehmet Turgut
- Department of Neurosurgery, Adnan Menderes University School of Medicine, TR-09100 Aydin, Turkey.
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Gabelmann A, Klein S, Kern W, Krüger S, Brambs HJ, Rieber-Brambs A, Pauls S. Relevant imaging findings of cerebral aspergillosis on MRI: a retrospective case-based study in immunocompromised patients. Eur J Neurol 2007; 14:548-55. [PMID: 17437615 DOI: 10.1111/j.1468-1331.2007.01755.x] [Citation(s) in RCA: 42] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The aim of the study was to assess neuroimaging patterns of cerebral aspergillosis with magnetic resonance imaging (1.5 T). The clinical and imaging data of nine patients were reviewed. Patients were included in the study if the diagnosis of aspergillosis was confirmed by either biopsy, autopsy, aspergillus antigen determination and/or neuroradiological and clinical response to specific treatment. Four patients had single or multiple abscesses presenting as ring-enhancing lesions on T1-weighted images, hypointensity of the ring on T2-weighted MR images and low to high signal intensity on diffusion-weighted imaging. Four patients had single or multiple infarctions affecting all compartments of the brain with hyperintensities on T2-weighted images in three of four patients, irregular parenchymal contrast enhancement in all patients and hemorrhagic transformation of the infarcted parenchyma in one patient. Diffusion-weighted images were positive in all ischemic areas. One patient with paranasal sinusitis developed a mycotic aneurysm of the internal carotid artery. Cerebral aspergillosis presents three principal neuroimaging findings: areas consistent with infarction; ring lesions consistent with abscess formation following infarction; and dural or vascular infiltration originating from paranasal sinusitis or orbital infiltration. Recognition of these patterns in cerebral aspergillosis may lead to more timely and effective diagnosis and treatment.
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Affiliation(s)
- A Gabelmann
- Diagnostic Imaging Center Dreilaendereck, Loerrach, Germany
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