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A young woman with ring-enhancing lesions
1Neurological Institute, Columbia University, New York, USA.
Summary
A patient with systemic lupus erythematosus developed a severe Aspergillus fumigatis infection, leading to brain lesions and endocarditis. This case highlights the risks of invasive fungal infections in immunocompromised individuals.
Area of Science:
- Infectious Diseases
- Neurology
- Rheumatology
Background:
- Corticosteroid therapy for systemic lupus erythematosus (SLE) can increase susceptibility to opportunistic infections.
- Invasive fungal infections, particularly aspergillosis, pose a significant risk in immunocompromised patients.
Observation:
- A non-neutropenic patient with SLE on corticosteroids presented with neurological symptoms including fever, headache, and seizures.
- Brain imaging revealed ring-enhancing lesions, suggestive of an infectious or neoplastic process.
Findings:
- Brain biopsy confirmed invasive Aspergillus fumigatis infection.
- Despite antifungal treatment, the patient's condition deteriorated.
- Post-mortem examination (necropsy) identified Aspergillus endocarditis affecting the mitral and tricuspid valves.
Implications:
- This case underscores the potential for severe, disseminated Aspergillus infections in patients with SLE, even without neutropenia.
- Early recognition and aggressive management of invasive fungal infections are crucial in immunocompromised patients.
- The findings emphasize the importance of considering fungal endocarditis in the differential diagnosis of unexplained fever and cardiac abnormalities in this population.