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Lethal subarachnoid bleeding under immunosuppressive therapy due to mycotic arteritis
Stefanie Weigel1, Stephan Kloska, Hans Gerd Kehl
1Department of Clinical Radiology, University Hospital of Muenster, Albert-Schweitzer-Strasse 33, 48149 Münster, Germany. weigels@uni-muenster.de
European Radiology
|March 17, 2004
Summary
A rare case of subarachnoid hemorrhage (SAH) in a pediatric cardiac transplant recipient was caused by fungal arteritis. This mycotic arteritis, linked to aspergillosis, presented with severe headaches and hypertension before the fatal event.
Area of Science:
- Neurology
- Cardiology
- Infectious Diseases
Background:
- Subarachnoid hemorrhage (SAH) is a rare complication following cardiac transplantation, especially in pediatric patients.
- Immunocompromising therapy in transplant recipients increases susceptibility to opportunistic infections.
Observation:
- A 10-year-old girl developed SAH 67 days after cardiac transplantation.
- Prior to the fatal SAH, she experienced arterial hypertension, severe headaches, and cerebrospinal fluid (CSF) pleocytosis.
- CT scans revealed an infarct in the left thalamus.
Findings:
- Conventional imaging (DSA, CT angiography) did not identify intracranial vascular malformations.
- Pathological examination confirmed SAH due to aspergillosis-related mycotic arteritis.
- This represents a rare cause of non-traumatic SAH in an immunocompromised child.
Implications:
- Highlights the importance of considering infectious etiologies, specifically mycotic arteritis, in the differential diagnosis of SAH in immunocompromised patients.
- Emphasizes the need for thorough pathological investigation when imaging is inconclusive for SAH.
- Suggests potential challenges in diagnosing and managing fungal arteritis in pediatric transplant recipients.