[Aspergillosis of the brain in a patient with pancytopenia]

The here presented case concerns a 74-year-old woman treated for many years with steroids and immunosuppressive drugs during pancytopenia. Seven days before her death she developed severe headaches and visual disorders, rapidly increasing disturbances of consciousness and a temperature of 40 degrees C. The course of the disease was violent with meningeal syndrome and cerebral coma. The cerebrospinal fluid was purulent, pleocytosis 1235/ml, with prevalence of polymorphonuclear leucocytes (88%) and an protein level increased to 210 mg%. In autopsy no mycotic changes were found in the internal organs whereas in microscopic examination of the brain the dominant finding was the presence of numerous filamentous bodies with septa characteristic of aspergillus which were visible both in microthrombi in the lumen of meningeal and interstitial vessels and in the areas of extensive necroses in both cerebral hemispheres and the brain stem as well as within granulomas occurring on the edges of necrotic foci and in the inflammatory infiltration of the brain base meninges. The presence of aspergillus hyphae was usually associated with a severe inflammatory reaction of polymorphonuclear leucocytes, acidophilic and plasmatic cells in microabscesses and in the inflammatory infiltration of meninges or in the form of granulomas composed mainly of multinucleated giant cells of Langhans or of foreign body type and mononuclear cells. The etiopathogenesis of these changes is discussed. The role of the facilitating factor could have been played by protracted therapy with steroids and immunosuppressive drugs and/or by pancytopenia itself which is probably associated with abnormal immunological response. Noteworthy is the fact that the seldom described mycotic changes caused by aspergillus concerned in the present case the central nervous system exclusively.