Primary intracerebral aspergillosis in an immunocompetent patient with no risk factors or clear cause: a case report.

INTRODUCTION

Intracranial aspergillosis (ICA) is an uncommon, life-threatening central nervous system infection that is caused by the Aspergillus species. Usually, ICA happens in immunocompromised patients. However, it can sometimes happen in immunocompetent patients, which poses a unique diagnostic and therapeutic challenge. Here we present a rare case of primary ICA in an immunocompetent patient.

PRESENTATION: A 60-year-old woman presented with aphasia, blurry vision, nausea, and vomiting in addition to a 1-month history of eye pain and decreased vision. Examination showed disorientation, gait apraxia, and sphincter dysfunction. A head computed tomography scan showed several hypodense infarction-like lesions, and on magnetic resonance imaging these lesions appeared to be endemic in nature mimicking metastatic lesions. Therefore, a biopsy was taken and subsequent pathological and immunohistochemical examination confirmed the diagnosis of aspergillosis.

DISCUSSION: ICA usually occurs in immunocompromised patients. Nevertheless, it can sometimes happen in immunocompetent patients, and the exact etiology of ICA in immunocompetent patients remains unknown. ICA poses a great diagnostic challenge due to the multiple differential diagnoses that can mimic this condition. Due to this, pathological examination and subsequent IHC staining play a crucial role in diagnosing this condition and differentiating it from other possible diagnoses. Finally, ICA can be treated using antifungal medication and/or surgical resection. However, the prognosis remains poor.

CONCLUSION

Physicians should keep ICA in mind as it can mimic intracranial lesions (such as metastasis and intracranial tuberculosis), which could be differentiated by either performing a pathological examination on a biopsy or by cerebrospinal fluid polymerase chain reaction tests.