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Aqueductal stenosis and hydrocephalus in an infant due to aspergillus infection
F K van Landeghem1, B Stiller, T N Lehmann
1Institute of Neuropathology, Humboldt-Universität, Berlin, Germany.
Insights
This case report details an infant with congenital anomalies who developed systemic aspergillosis post-surgery. A rare brain aspergilloma caused aqueductal stenosis and obstructive hydrocephalus, leading to the infant's death.
Area of Science:
- Pediatric Infectious Diseases
- Neuro-pediatrics
- Medical Mycology
Background:
- Infantile hydrocephalus often results from aqueductal stenosis.
- Congenital anomalies, including aplasia cutis congenita and hypoplastic left heart syndrome, present complex challenges in neonates.
Observation:
- A neonate with multiple congenital anomalies developed systemic aspergillosis following cardiac surgery.
- The infant received combined systemic and intrathecal antifungal therapy (flucytosine and amphotericin B) starting on post-operative day 17.
Findings:
- Post-mortem examination revealed disseminated Aspergillus infection, including meningitis, brain aspergillomas, and microabscesses.
- A unique finding was an aspergilloma causing aqueductal stenosis and obstructive hydrocephalus, a previously unreported etiology.
- Aspergillus hyphae were exclusively identified within the aqueductal aspergilloma.
Implications:
- This case highlights a novel cause of aqueductal stenosis and obstructive hydrocephalus in an infant.
- It underscores the potential for invasive fungal infections in critically ill neonates with complex congenital conditions.
- Early recognition and aggressive management of invasive aspergillosis are crucial in immunocompromised infants.
Abstract:
Aqueductal stenosis is a common cause of hydrocephalus during infancy. We report on an infant born with aplasia cutis congenita at the scalp vertex and hypoplastic left heart syndrome developing systemic aspergillosis after cardiac surgery. The infant died at the age of 76 days despite systemic antimycotic therapy with a combination of flucytosine and amphotericin B. Therapy started at post-operative day 17 and was also applied intrathecally. Post-mortem examination revealed meningitis, multiple brain aspergillomas and microabscesses with focal ependymitis, focal bronchopneumonia, and necrotizing enterocolitis. One of the brain aspergillomas was located close to the aqueduct causing an aqueductal stenosis and an obstructive hydrocephalus. Histologically, aspergillus hyphae could only be detected in the aspergilloma of the aqueduct. To the best of our knowledge, this is the first reported case of an aqueductal stenosis caused by an aspergilloma.