CNS-manifestation of aspergillosis in an extremely low-birth-weight infant

Invasive aspergillosis is a rare condition in term and preterm infants. We present here the fatal case of a 28-week gestational age preterm baby who developed pulmonary, hepatic and central nervous system aspergillosis during the first days of life. A hyperechogenic lesion adjacent to the lateral ventricle was diagnosed by ultrasound and initially considered to represent periventricular leukomalacia. Within several days the lesion increased in size and was then falsely considered to be an intraventricular haemorrhage. Aspergillus fumigatus was ultimately isolated in the tracheal aspirates, ascites and in material recovered by open brain biopsy. Despite treatment with conventional and liposomal amphotericin B the infant patient died.

Invasive aspergillosis has to be considered in the differential diagnosis of an unusual hyperechogenic brain lesion in very low-birth-weight infants with persistent symptoms and signs of systemic infection despite broad-spectrum antibacterial therapy. Consideration of this diagnosis should result in an aggressive diagnostic work-up to allow early initiation of an appropriate treatment.