Middle and posterior fossa aspergilloma

Area of Science:

• Neurology
• Mycology
• Surgical Pathology

Background:

• Brain aspergilloma is an uncommon fungal infection, particularly rare in immunocompetent patients.
• Solitary intracranial masses due to aspergilloma present diagnostic challenges.
• Preoperative diagnosis is difficult, necessitating intraoperative evaluation.

Observation:

• A 27-year-old immunocompetent male presented with neurological deficits and a cranial mass.
• Previous mastoidectomy for chronic otitis media and a history of earache were noted.
• Imaging revealed a large space-occupying lesion in the cranial fossa, initially suspected as a granulomatous mass.

Findings:

• Despite surgical excision and initial improvement, the patient developed hydrocephalus and succumbed to the illness.
• Postoperative histopathology confirmed the diagnosis of brain aspergilloma.
• Intraoperative squash smears or frozen sections are crucial for prompt diagnosis.

Implications:

• This case underscores the importance of considering aspergilloma in immunocompetent patients with intracranial masses.
• Early diagnosis via intraoperative pathology aids in initiating appropriate antifungal therapy alongside surgery.
• Prompt diagnosis and treatment are critical for improving outcomes in rare fungal brain infections.