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Stereotactic drainage of Aspergillus brain abscess with long-term survival: case report and review
1Division of Neurological Surgery, Milton S. Hershey Medical Center, Pennsylvania State University, Hershey.
Abstract:
Aspergillus species are second only to Cryptococcus neoformans as the most common cause of fungal infections of the central nervous system in immunocompromised patients. Survival following treatment of Aspergillus brain abscess has been reported only 4 times. In each case, craniotomy was performed for abscess drainage. We present a case of long-term survival following stereotactic drainage of a bilateral Aspergillus brain abscess. In all reported cases, including the present one, histological examination of the abscess contents established the correct diagnosis. Amphotericin B was used in combination with operation in 4 of the 5 cases of long-term survival.
Insights
Long-term survival is possible for immunocompromised patients with Aspergillus brain abscesses. Stereotactic drainage, combined with antifungal therapy, offers a viable treatment option for these rare fungal infections.
Area of Science:
- Medicine
- Mycology
- Neurosurgery
Background:
- Fungal infections of the central nervous system (CNS) are a significant concern in immunocompromised individuals.
- Aspergillus species are a leading cause of CNS fungal infections, second only to Cryptococcus neoformans.
- Aspergillus brain abscesses are rare and associated with a poor prognosis, with limited reported cases of long-term survival.
Observation:
- This report details a case of successful long-term survival in a patient with a bilateral Aspergillus brain abscess.
- The patient underwent stereotactic drainage for the abscess.
- Histological examination of abscess contents was crucial for establishing the diagnosis in all reported cases.
Findings:
- Stereotactic drainage, a less invasive surgical approach than craniotomy, facilitated long-term survival in this case of Aspergillus brain abscess.
- The diagnosis of Aspergillus brain abscess was confirmed through histological examination of abscess contents.
- Amphotericin B, an antifungal medication, was utilized in conjunction with surgical intervention in most cases of successful long-term survival.
Implications:
- Stereotactic drainage represents a potentially effective treatment modality for Aspergillus brain abscesses, offering an alternative to craniotomy.
- Aggressive management combining surgical intervention and systemic antifungal therapy, such as Amphotericin B, is critical for improving outcomes.
- Further research into optimal treatment strategies for CNS aspergillosis is warranted to enhance patient survival rates.