Cerebral aspergillosis caused by Aspergillus flavus following seasonal influenza infection in a patient receiving ibrutinib for Waldenström's macroglobulinemia.

Ibrutinib and influenza infection are increasingly recognized as emerging risk factors for invasive aspergillosis. We describe a patient receiving ibrutinib therapy who developed cerebral aspergillosis caused by Aspergillus flavus with concurrent probable invasive pulmonary aspergillosis related to A. fumigatus following influenza infection. The patient underwent neurosurgical debridement and isavuconazole therapy. Consequently, the cerebral aspergillosis was successfully controlled. This case highlights the need for heightened clinical vigilance for invasive aspergillosis with cerebral involvement in patients with emerging risk factors such as ibrutinib, particularly during influenza season. Furthermore, it underscores the critical importance of obtaining tissue specimens for direct molecular analysis.