Teaching Case

Infection and convulsions in an immuno-compromized patient with pulmonary aspergillosis.

A 55 year old man, treated in our institution for a multiple myeloma was admitted to the emergency department for seizures and fever. His immunological condition was alterated by chemotherapy treatment and he was receiving anti-infectious treatment for invasive and pulomary aspergillosis. An MRI is performed.

Aspergillosis refers to a group of diseases including allergic, toxic, inflammatory, granulomatosis, invasive and disseminated forms of disease in which Aspergillus species are involved. Aspergillus fumigatus is the most specific species most often recovered from patients with invasive or disseminated infections. Invasive and disseminated aspergillosis occur in patients with underlying predisposing conditions. Invasive aspergillosis affects usually the lungs. Intravascular invasion may result in systemic dissemination. The organs most commonly affected are the heart , the bones, the kidneys, the gastrointestinal tract and the central nervous system (CNS). CNS aspergillosis occurs most often secondary to haematogenous dissemination from the lungs or from endocarditis. The lesion most frequently encountered during brain aspergillosis is fungal abscess. The other involvements are meningitis, meningoencephalitis, subcortical hemorrhagic infarcts secondary to invasion and thrombosis of intracranial vessels. The main radiological feature of brain aspergillosis is brain abscess and is not specific to this germ. In the context of invasive aspergilosis, the diagnosis is based on immunological analysis,cerebrospinal fluid examination and culture. The regression of the lesions after antifungal chemotherapy confirms the diagnosis. Rarely a brain biopsy is required to lead to the diagnosis. The differential diagnosis in this context of brain infection include all other bacteriological, fungal, and parasitic agent. In the present case of disseminated aspergillosis, the diagnosis of brain aspergillosis was based on the serological examinations.