Invasive aspergillosis leading to fatal cerebral hemorrhage: a case report and comprehensive literature review.

Aspergillus fumigatus significantly threatens immunocompromised individuals by causing potentially fatal diseases, primarily invasive aspergillosis (IA). IA, mostly affecting the lungs, can disseminate to other organs, including the central nervous system (CNS), leading to high mortality rates. We present the case of an 84-year-old immunocompetent male with a history of significant comorbidities, who developed a lethal subarachnoid and tetraventricular hemorrhage. Initial symptoms included paroxysmal neuralgic pain and ophthalmic manifestations. Despite diagnostic efforts, the infection was confirmed only after a positive Aspergillus galactomannan antigen test on cerebrospinal fluid, post-mortem microbiological culture, and mass spectrometry (MS) authentication. The patient exhibited rapid deterioration and succumbed due to the erosion of a mycotic cerebral aneurysm of the left internal carotid artery. Diagnosing IA, particularly isolated CNS IA in immunocompetent patients, is challenging due to its nonspecific symptoms and difficulty detecting the pathogen in standard diagnostic tests. This article emphasizes the pivotal role of pathological examination to obtain a definitive diagnosis, assess fungal infiltration of brain vessels, and thus clarify the accurate source of fatal brain hemorrhages.