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Intracranial mycotic aneurysm caused by Aspergillus--case report
Abstract:
A 75-year-old female with chronic renal failure diagnosed as Wegener's granulomatosis was receiving steroids and immunosuppressive agents when subarachnoid hemorrhage developed. Cerebral angiography showed a fusiform aneurysm arising from an angular branch of the left middle cerebral artery. Hemorrhage occurred and the aneurysm was excised by emergency surgery. Microscopic examination of the aneurysm revealed dense infiltration of hyphae identified as Aspergillus. She died of subsequent hemorrhage. Autopsy showed numerous Aspergillus hyphae in the lung. Fungal mycotic aneurysm should be considered in the differential diagnosis of an immunocompromised patient with subarachnoid hemorrhage.
Insights
A fungal infection caused a brain aneurysm in an immunocompromised patient, leading to subarachnoid hemorrhage and death. This case highlights the importance of considering fungal mycotic aneurysms in similar patients.
Area of Science:
- Neurology
- Infectious Diseases
- Pathology
Background:
- Wegener's granulomatosis is a rare autoimmune disease that can affect various organs.
- Immunosuppressive therapy is often required for managing autoimmune conditions, increasing susceptibility to infections.
- Subarachnoid hemorrhage is a critical neurological emergency often caused by ruptured blood vessels in the brain.
Observation:
- A 75-year-old female with chronic renal failure and Wegener's granulomatosis presented with subarachnoid hemorrhage.
- Cerebral angiography revealed a fusiform aneurysm on a middle cerebral artery branch.
- Surgical excision of the aneurysm was performed due to active bleeding.
Findings:
- Microscopic analysis of the excised aneurysm confirmed extensive Aspergillus fungal hyphae.
- The patient experienced recurrent hemorrhage and succumbed to the condition.
- Autopsy revealed widespread Aspergillus hyphae in the lungs, indicating systemic fungal dissemination.
Implications:
- Fungal mycotic aneurysms are a critical consideration in immunocompromised patients presenting with subarachnoid hemorrhage.
- Early diagnosis and treatment of fungal infections are crucial in preventing life-threatening complications.
- This case underscores the need for a high index of suspicion for opportunistic infections in immunocompromised individuals.