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Abstract：
BACKGROUND: Invasive aspergillosis of the central nervous system is a rare but increasingly prevalent disease. We present the unusual case of an immunosuppressed patient suffering from unexpected superinfected invasive aspergillosis with cerebral, pulmonal, and adrenal manifestations, mimicking a metastasized bronchial carcinoma. This report reveals the importance of including aspergillosis in the differential diagnosis of a cerebral mass lesion in the light of unspecific clinical findings.
METHODS: A 58-year-old immunocompromised female presented to our emergency department with a single tonic-clonic seizure. Imaging showed a ring enhancing cerebral mass with perifocal edema and evidence of two smaller additional hemorrhagic cerebral lesions. In the setting of a mass lesion in the lung, and additional nodular lesions in the left adrenal gland the diagnosis of a metastasized bronchus carcinoma was suspected and the cerebral mass resected. However, histology did not reveal any evidence for a neoplastic lesion but septate hyphae consistent with aspergillus instead and microbiological cultures confirmed concomitant staphylococcal infection.
CONCLUSIONS: A high index of suspicion for aspergillus infection should be maintained in the setting of immunosuppression. Clinical and radiological findings are often unspecific and even misleading. Definite confirmation usually relies on tissue diagnosis with histochemical stains. Surgical resection is crucial for establishing the diagnosis and guiding therapy with targeted antifungal medications.
METHODS: A 58-year-old immunocompromised female presented to our emergency department with a single tonic-clonic seizure. Imaging showed a ring enhancing cerebral mass with perifocal edema and evidence of two smaller additional hemorrhagic cerebral lesions. In the setting of a mass lesion in the lung, and additional nodular lesions in the left adrenal gland the diagnosis of a metastasized bronchus carcinoma was suspected and the cerebral mass resected. However, histology did not reveal any evidence for a neoplastic lesion but septate hyphae consistent with aspergillus instead and microbiological cultures confirmed concomitant staphylococcal infection.
CONCLUSIONS: A high index of suspicion for aspergillus infection should be maintained in the setting of immunosuppression. Clinical and radiological findings are often unspecific and even misleading. Definite confirmation usually relies on tissue diagnosis with histochemical stains. Surgical resection is crucial for establishing the diagnosis and guiding therapy with targeted antifungal medications.
摘要：
背景：中枢神经系统侵袭性曲霉病是一种罕见但日益普遍的疾病。我们介绍了一名免疫抑制患者的不寻常病例，该患者患有意外的超感染侵袭性曲霉病，肺门,和肾上腺表现，模仿转移的支气管癌。该报告揭示了根据非特异性临床发现在脑肿块病变的鉴别诊断中包括曲霉病的重要性。
方法：一名58岁的免疫功能低下的女性因一次强直阵挛性癫痫发作出现在我们的急诊科。成像显示一个环形增强的脑肿块，伴有病灶周围水肿，并有两个较小的其他出血性脑病变的证据。在肺部肿块病变的背景下，以及左肾上腺的其他结节性病变，怀疑诊断为转移的支气管癌，并切除了脑肿块。然而,组织学没有发现任何肿瘤病变的证据，但与曲霉菌一致的菌丝分离，微生物培养证实伴随葡萄球菌感染。
结论：在免疫抑制的情况下，应保持对曲霉菌感染的高度怀疑。临床和放射学发现通常是无特异性的，甚至是误导性的。明确的确认通常依赖于组织化学染色的组织诊断。手术切除对于建立诊断和指导靶向抗真菌药物治疗至关重要。
方法：一名58岁的免疫功能低下的女性因一次强直阵挛性癫痫发作出现在我们的急诊科。成像显示一个环形增强的脑肿块，伴有病灶周围水肿，并有两个较小的其他出血性脑病变的证据。在肺部肿块病变的背景下，以及左肾上腺的其他结节性病变，怀疑诊断为转移的支气管癌，并切除了脑肿块。然而,组织学没有发现任何肿瘤病变的证据，但与曲霉菌一致的菌丝分离，微生物培养证实伴随葡萄球菌感染。
结论：在免疫抑制的情况下，应保持对曲霉菌感染的高度怀疑。临床和放射学发现通常是无特异性的，甚至是误导性的。明确的确认通常依赖于组织化学染色的组织诊断。手术切除对于建立诊断和指导靶向抗真菌药物治疗至关重要。
