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Published on: February 17, 2023
Aspergillus terreus brain abscess mimicking tumor progression in a patient with treated glioblastoma multiforme
D M Damek1, K O Lillehei, B K Kleinschmidt-DeMasters
1Departments of Neurology, University of Colorado, Health Sciences Center, Aurora, CO 80045, USA.
Objective:
To detail a case of Aspergillus terreus brain abscess in a patient undergoing treatment for malignant glioma. Central nervous system aspergillosis usually occurs in patients with hematopoietic neoplasms or post transplantation, not in those with solid tumors. Most systemic invasive mold infections are attributable to Aspergillus fumigatus or Aspergillus flavus.
Patient And Methods:
The patient had received external beam radiation, temozolomide chemotherapy, and high-dose steroids, and had lymphopenia, but not sustained neutropenia. She developed a brain mass that mimicked tumor progression by neuroimaging criteria; infection was not a consideration.
Results:
Brain biopsy showed fungal cerebritis and cultures grew A. terreus, a variant being reported with greater frequency as a pathogen in patients with risk factors for aspergillosis.
Conclusion:
Brain tumor patients who receive steroids to control their peritumoral edema may be particularly susceptible to cerebral A. terreus infection, especially when they additionally develop the lymphopenia commonly associated with temozolomide.
Insights
A rare Aspergillus terreus brain abscess occurred in a patient with malignant glioma, highlighting a potential risk in brain tumor patients on steroids and temozolomide chemotherapy, leading to lymphopenia.
Area of Science:
- Neuroscience
- Mycology
- Oncology
Background:
- Central nervous system aspergillosis is rare in solid tumor patients, typically affecting those with hematologic neoplasms or post-transplant.
- Invasive mold infections are commonly caused by Aspergillus fumigatus or Aspergillus flavus.
Observation:
- A patient with malignant glioma developed a brain mass mimicking tumor progression on neuroimaging.
- The patient had received radiation, temozolomide chemotherapy, and high-dose steroids, resulting in lymphopenia but not sustained neutropenia.
Findings:
- Brain biopsy revealed fungal cerebritis, with cultures identifying Aspergillus terreus.
- Aspergillus terreus is increasingly reported as a pathogen in immunocompromised patients.
Implications:
- Brain tumor patients on steroids for edema may be susceptible to cerebral Aspergillus terreus infections.
- Temozolomide-induced lymphopenia may increase susceptibility in these patients.
