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.