Cerebral Aspergillosis in an Immunocompetent Patient: A Case Report

Aspergillus is a fungus found in the environment. In an immunecompetent person, inhalation of spores may cause localized infection. In immune compromised patients, these fungi can cause life-threatening invasive infections. Invasive aspergillosis has a poor prognosis.
We describe a case of cerebral aspergillosis in an immunecompetent patient. A 29-year-old woman was admitted with seizures and headaches. Magnetic resonance imaging (MRI) of the brain showed two masses one mass in the left frontal lobe and one in parietal lobe. Excisional biopsies showed granulomatous reactions, mixed inflammatory infiltration, fibrosis, and necropurulent material mixed with fungal hyphae featuring acute-angle branching and septation, which was compatible with aspergillosis. Amphotericin B deoxycholate (1 mg/kg IV daily) was begun. The results of testing for human immunodeficiency virus (HIV) and nitroblue tetrazolium (NBT) for chronic granulomatous disease (CGD) were negative. The patient had two subsequent recurrences, and surgery and medical treatments were prescribed. Presently, after two years of follow-up, she has no symptoms and her MRI is normal.
Most cases of invasive aspergillosis show that this organism is pathogenic in immunocompromised patients; however, some case reports show that invasive aspergillosis may not be so rare in immunocompetent patients. In these patients, virulent and drug-resistant forms of aspergillus may be responsible for the disease, and treatment with antifungal agents is often ineffective, so that surgical excision is required.