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Recurrent Stroke and Fatal Ruptured Mycotic Aneurysm Caused by Invasive Aspergillus fumigatus Infection
Istiaq Mian1, Sam Ives2, Garry Jean-Louis3
1SSM Health Saint Mary's Hospital, Madison, Wisconsin, mianx003@gmail.com.
Summary
Invasive aspergillosis can spread to the central nervous system (CNS), causing rare but fatal complications like mycotic aneurysms and subarachnoid hemorrhage (SAH). Early empirical antifungal treatment is crucial for at-risk patients.
Area of Science:
- Mycology
- Infectious Diseases
- Neurology
Background:
- Aspergillus species are common fungi causing invasive infections, especially in immunocompromised individuals.
- Invasive aspergillosis primarily affects the lungs but can disseminate to the central nervous system (CNS).
- CNS aspergillosis can manifest as abscesses or, rarely, mycotic aneurysms leading to subarachnoid hemorrhage (SAH).
Observation:
- A 48-year-old male with laryngeal squamous cell cancer on chemotherapy and steroids presented with neurological symptoms (dysarthria, weakness).
- The patient had concurrent lung and CNS infections due to Aspergillus species.
- Despite antifungal treatment, he developed a fatal SAH from a biopsy-proven mycotic aneurysm.
Findings:
- Intracranial mycotic aneurysms are rare complications of CNS aspergillosis.
- Mycotic aneurysms can lead to subarachnoid hemorrhage (SAH), a potentially fatal outcome.
- Mortality rates for CNS aspergillosis are exceptionally high.
Implications:
- Immunosuppressed patients with neutropenia or on chronic steroids and concurrent pulmonary/CNS infections require prompt consideration for empirical antifungal therapy.
- Early diagnosis and treatment are critical for improving outcomes in CNS aspergillosis.
- This case highlights the severe risks associated with invasive aspergillosis in immunocompromised hosts.
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