Preexisting Cerebral Aspergillosis Successfully Treated After Liver Transplantation: A Case Report

Invasive aspergillosis (IA) is a rare condition that generally affects immunosuppressed patients. The mortality of IA is known to be >90% in liver transplantation (LT) recipients; the lung is the most commonly affected organ, followed by the brain. There have been reports in the literature of cerebral aspergillosis (CA) in LT recipients. In all previous reports, CA developed after LT. We present the first case (to the best of our knowledge) of preexisting CA diagnosed and successfully treated after LT.

A 59-year-old male patient underwent emergency deceased-donor LT for alcoholic liver cirrhosis. Preoperative imaging showed multiple lesions in both cerebral hemispheres, indicative of brain abscess or metastases. Before definitive diagnosis of the brain lesion, the deceased-donor LT was performed. On postoperative day 15, the patient developed a fever of 38.0°C and drowsy mental status. Magnetic resonance imaging showed increased number and size of brain abscesses. Stereotactic brain abscess aspiration was performed, and pathologic findings revealed aspergillosis. Voriconazole was started immediately. The patient improved steadily and was discharged 1 month after initiation of voriconazole treatment.

This case is the first report of preexisting CA treated successfully after LT. Voriconazole is a potent therapeutic agent of CA. When LT is performed with an undiagnosed brain lesion, aggressive diagnostic measures are necessary postoperatively. If CA is diagnosed, successful treatment may be possible with voriconazole.