{"id":"c7099037-3cb4-47bc-881e-0d53d06a198e","slug":"brain-aspergilloma-in-an-immunocompetent-individual-a-case-report","title":"Brain aspergilloma in an immunocompetent individual: A case report","authors":["João Ribeiro Memória","Erlan Pércio Lopes Rufino","Pedro Lukas do Rêgo Aquino","Francisco Vaz Guimarães Filho","Túlio Maranhão Neto","Herika Karla Negri Brito de Vasconcelos"],"abstract":"Background: Aspergillosis is caused by fungi from the Aspergillus species, mainly Aspergillus fumigatus. Patients with aspergillosis typically have an underlying immunosuppression, and it is rare within the central nervous system (CNS) in an immunocompetent host. The mortality rate is as high as 90% if untreated, and the diagnosis is usually delayed due to nonspecific clinical presentation. This study described a case of CNS aspergillosis in an immunocompetent patient, through which we sought to discuss the current knowledge regarding brain Aspergillus focusing in the immunocompetent host. Case Description: A 45-year-old male presented with 2 years of low-intensity headache and history of chronic sinusitis with epistaxis in the left nostril. Fifteen days before admission, he had high-intensity headache, episodes of transient aphasia, and seizure. Imaging showed a contrast-enhancing mass within the left maxillary sinus and another lesion in the left frontal lobe. The left frontal craniotomy was conducted, and complete resection was achieved. Biopsy identified A. fumigatus, and antifungal therapy was initiated. After 2 weeks, a new lesion was detected in the right frontal lobe, and the patient underwent a new procedure with complete lesion resection. Follow-up at 3 weeks did not reveal any evidence of residual or recurrent disease. The patient did not develop neurological complaints and was referred for resection of the remaining lesion by an otolaryngology team. Conclusion: Being one of the few cases reporting a successful outcome for brain aspergilloma in an immunocompetent patient after complete surgical resection and amphotericin B and itraconazole therapy, we sought to reveal novel insight into brain aspergillosis. Aspergillosis is caused by ubiquitous and saprophytic fungi of the Aspergillus species. The most common human pathogen is Aspergillus fumigatus.[ 3 , 13 ] Aspergillus spores are airborne and inhaled by the host, entering into the respiratory system. In most cases, its pathogenicity is not high, and immunocompetent host infection is rare.[ 11 , 14 ] Patients with aspergillosis typically have an underlying immunosuppression factor, including human immunodeficiency virus (HIV) and prolonged hospitalization.[ 3 , 10 , 13 , 14 ] Aspergillosis within the central nervous system (CNS) is very rare in the immunocompetent host. The fungal may then gain access to the brain by direct spread from the paranasal sinuses or hematogenic pathways.[ 10 , 13 ] In general, the mortality rate is as high as 90% if untreated. In most cases, the diagnosis is significantly delayed due to the nonspecific clinical presentation.[ 9 , 13 , 18 ] We reported a rare case of CNS aspergillosis in an immunocompetent patient, and this article sought to reveal the current knowledge regarding brain Aspergillus focusing on the immunocompetent host.","thumbnailUrl":"https://sni-digital-videos.s3.amazonaws.com/articles/c7099037-3cb4-47bc-881e-0d53d06a198e/featured/hero-1781563298858.png","publishDate":"2020-07-25T00:00:00.000Z","doi":"10.25259/SNI_321_2020","categories":["Infection","Case Report"],"fullTextUrl":"https://surgicalneurologyint.com/api/articles/c7099037-3cb4-47bc-881e-0d53d06a198e/pdf"}