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Disseminated cerebral aspergillosis complicated by thrombotic microangiopathy

Robynn Lester1, Deirdre Church1,2, Anshula Ambasta1,3,4

  • 1Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.

Medical Mycology Case Reports
|July 24, 2019
PubMed

Insights

Disseminated cerebral invasive aspergillosis (IA) occurred in a patient with anti-glomerular basement membrane disease. This rare case highlights IA complications and treatment challenges, including drug toxicity.

Area of Science:

  • Medical Mycology
  • Immunology
  • Nephrology

Background:

  • Invasive aspergillosis (IA) is a severe fungal infection with high mortality, particularly cerebral IA.
  • Immunosuppressive therapy, including cyclophosphamide, rituximab, and prednisone, increases susceptibility to IA.
  • Anti-glomerular basement membrane glomerulonephritis is a rare autoimmune kidney disease.

Observation:

  • A unique case of disseminated cerebral IA in a patient with anti-glomerular basement membrane glomerulonephritis is presented.
  • The patient experienced IA despite immunosuppressive treatment, leading to neurological complications.
  • Thrombotic microangiopathy developed secondary to IA, with normal ADAMTS13 levels.

Findings:

  • Disseminated IA has not been previously reported in the context of anti-glomerular basement membrane glomerulonephritis.
  • IA can precipitate thrombotic microangiopathy even with normal ADAMTS13 activity.
  • Voriconazole toxicity required a switch to isavuconazole for effective IA treatment.

Implications:

  • This case expands the understanding of IA manifestations in immunocompromised patients with autoimmune diseases.
  • It underscores the importance of considering IA in patients with unexplained neurological symptoms and immunosuppression.
  • The case highlights challenges in IA management, including drug toxicity and the need for alternative antifungal agents.
Keywords:
Cerebral aspergillosisInvasive aspergillosisIsavuconazoleThrombotic microangiopathyVoriconazole-induced periostitis

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