2841
Views & Citations1841
Likes & Shares
Invasive aspergillosis is a disease known to manifest in immunocompromised
hosts. It is an opportunistic disease which spreads by air and occurs
predominantly in lungs, although dissemination to virtually any organ is
possible. We report a case of invasive aspergillosis involving paranasal
sinuses and brain, in an immunocompetent host, which mascarded as primary brain
neoplasm radiologically.
Keywords: Invasive Aspergillosis,
Immunocompetent host.
INTRODUCTION
Invasive aspergillosis
remains the most invasive fungal infection worldwide despite ongoing
improvements in medical therapy.1 Invasive aspergillosis has been
reported in patients with profound neutropenia or patients with any form of
immunodeficiency. However, invasive aspergillosis is rarely found in
immunocompetent patients. Aspergillosis of the CNS is a rare disease,
especially if the patient’s immune system is not compromised. Because of the
high mortality rate of this infection, early diagnosis and prompt initiation of
treatment are crucial [1]. Here we present a case with invasive aspergillosis
having no underlying immunodeficiency state apparently.
CASE REPORT
A 40 year old male
presented with headache, two episodes of seizures and nasal stuffiness with duration
of two weeks. On examination a mass was
seen coming out of the anterior ethmoids and filling the middle meatus. On
nasal endoscopy the mass was seen invading the lamina papyrecea and eroding the
underlying bone. A contrast-enhanced MRI scan was done and the radiological
differential diagnosis was given as Sinonasal adenocarcinoma with brain
involvement, Lymphoma & IgG4 Sclerosing disease (Figure 1). An
endoscopic transnasal biopsy (Figure 2) was done and asubsequent
interventional brain surgery was performed and the biopsy was subjected for
histopathological examination (Figure 3, 4).
DISCUSSSION
Invasive aspergillosis is a disease caused by
filamentous fungi. The most common species is Aspergillus fumigates [2].
Aspergillus is a mold with septate hyphae about 2-4 microns in diameter,
ubiquitous in the environment and spreads by inhalation of spores [3].Invasive
disseminated form is mainly a disease of immune-compromised host and is often a
fatal infection [4].The condition was reported mainly from Sudan but also from
other areas, including the Indian subcontinent [5]. Central nervous system
(CNS) aspergillosis is very rare in immunocompetent patients. The infections
mostly occur through hematogenous dissemination from a focus, such as lung
infection, or rarely through direct extension from the paranasal sinuses [6].
In present case patient had invasive
aspergillosis with involvement of paranasal sinuses with extension into frontal
lobe.No underlying immunodeficiency status was found in the form of diabetes,
alcoholism, past respiratory infection and other immunodeficiency status. The
definitive diagnosis is made with histological tests.
CONCLUSION
Invasive aspergillosis generally occurs in immunosuppressed patients. It may also rarely occur in immunocompetent individuals. Histopathology along with ancillary fungal stains had proved the diagnosis of invasive cerebral aspergillosis.
1. Raja N, Singh NN (2006) Disseminated invasiveaspergillosis
in an apparently immune- competent host.J MicrobiolImmunol Infect 39:
73-77.
2. Kędziora
K, et al. (2008) Invasive aspergillosis of the paranasal sinuses, lung and
brain. Polish PneumonolAllergol 76: 400–406.
3. Gupta
S, et al. (2004) Invasive Aspergillosis in an Immunocompetent Host. JK Sci 6:
171-175.
4. Sethi
P, et al. (2012) Invasive aspergillosis
in an immunocompetent host. J Oral MaxillofacPathol 16: 297-300.
5. Lim J. et al. (2010) Isolated Aspergillosis of the
Brain in an Immunocompetent Patient: A Case Report.J KorSoc Mag Resonance Med
14: 64-68.
6. Warinthorn P (2005) MR features of Cerebral Aspergillosis in an
immunocompetent patient: Correlation with Histology and Elemental Analysis. Am
J Neuroradiol26:835-838.
QUICK LINKS
- SUBMIT MANUSCRIPT
- RECOMMEND THE JOURNAL
-
SUBSCRIBE FOR ALERTS
RELATED JOURNALS
- BioMed Research Journal (ISSN:2578-8892)
- Journal of Nursing and Occupational Health (ISSN: 2640-0845)
- Advance Research on Alzheimers and Parkinsons Disease
- Chemotherapy Research Journal (ISSN:2642-0236)
- International Journal of Radiography Imaging & Radiation Therapy (ISSN:2642-0392)
- Journal of Oral Health and Dentistry (ISSN: 2638-499X)
- Journal of Pathology and Toxicology Research