CNS Aspergillosis: A Downside of Corticosteroid Use

Glucocorticoids are ubiquitously used by physicians for a myriad of diseases. Though powerful and potentially lifesaving, sometimes the dangerous side effects are not at the forefront of our medical decision-making. By immunosuppressing patients, glucocorticoids can place patients at increased risk for not only the metabolic effects of chronic glucocorticoid use but also increased risk for opportunistic infections. Patients at increased risk include those on prolonged courses or those that require high doses. We report a case of a 34-year-old man who was initiated on glucocorticoids for an unknown rheumatologic disease and presented with generalized weakness, fatigue, nausea, and vomiting. The patient experienced a seizure, which prompted head imaging. A mass was found and eventually biopsied, which was notable for Aspergillus fumigatus. The patient was initiated on antifungals for CNS aspergillosis and recovered.