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[Multiple Aspergillus brain abscesses complicated by bronchial asthma]
N Katayama1, H Miyazaki, M Fujimura
1Department of Internal Medicine, Takaoka Municipal Hospital, Toyama, Japan.
Abstract:
A 35-year-old man was hospitalized for the treatment of severe asthma attack. His condition improved with intensive steroid chemotherapy under artificial ventilation. On the 12th hospital day, he was taken off respirator support but lost consciousness afterward. Computed tomography of the brain disclosed multiple hypodense lesions with bleeding. T1-weighted magnetic resonance imaging disclosed low-intensity lesions containing high-intensity areas. T2-weighted images showed heterogeneous high-intensity lesions. The autopsy specimen demonstrated multiple brain abscesses. Histologic examination revealed branching fungal hyphae in abscess walls and also extending through arterial walls with emboli. These findings yielded a diagnosis of multiple Aspergillus infarct abscesses of the brain.
Insights
A severe asthma attack led to a rare fungal brain infection. Autopsy revealed multiple Aspergillus abscesses, highlighting a critical complication of intensive steroid therapy.
Area of Science:
- Neurology
- Infectious Diseases
- Mycology
Background:
- Severe asthma exacerbations often require intensive treatment, including mechanical ventilation and high-dose corticosteroids.
- Immunosuppression secondary to treatment can predispose patients to opportunistic infections.
Observation:
- A 35-year-old male patient with severe asthma developed neurological deficits after mechanical ventilation withdrawal.
- Brain imaging revealed multiple lesions consistent with infarcts and hemorrhage.
- Autopsy confirmed multiple brain abscesses.
Findings:
- Histological examination of the brain abscesses revealed fungal hyphae consistent with Aspergillus species.
- Fungal elements were observed within the abscess walls and invading arterial walls, suggesting angioinvasion and embolic spread.
- The final diagnosis was multiple Aspergillus infarct abscesses of the brain.
Implications:
- This case underscores the potential for invasive fungal infections, such as Aspergillus brain abscesses, in immunocompromised patients.
- Early recognition and prompt treatment of invasive fungal sinusitis are crucial to prevent central nervous system dissemination.
- Clinicians should maintain a high index of suspicion for opportunistic infections in patients receiving prolonged immunosuppressive therapy.