Invasive pulmonary and central nervous system aspergillosis: A case report and literature review

Invasive aspergillosis primarily affects individuals with compromised immune systems. This study endeavors to suggest the importance of early diagnosis and treatment related to central nervous system (CNS) aspergillosis. Recognizing the typical and atypical imaging characteristics of CNS aspergillosis enables the early and aggressive treatment of an otherwise rapidly fatal infection. We reported a case of an elderly patient with a history of non-Hodgkin lymphoma and prostate cancer who underwent repeated chemotherapy and subsequently experienced a sudden disturbance of consciousness. The diagnosis was affirmed through metagenomic next-generation sequencing (mNGS) of sputum and cerebrospinal fluid. The treatment encompassed systemic antifungal agents and intrathecal injection of amphotericin B. Metagenomic sequencing of sputum and cerebrospinal fluid detected Aspergillus fumigatus and Aspergillus flavus, leading to a diagnosis of invasive pulmonary and CNS aspergillosis. Although the patient actively received combined systemic antifungal drugs (voriconazole and amphoteric B liposome) and intrathecal injection of amphotericin B, he ultimately succumbed to the infection. A review of similar cases from PubMed and Medline from 2014 to 2024, encompassing 64 patients, showed that while early diagnosis and combination therapy have improved survival rates, outcomes remain suboptimal. Invasive aspergillosis has a high mortality rate and requires early diagnosis and treatment. Metagenomic sequencing of pathogenic microorganisms constitutes a convenient approach to facilitate the early diagnosis of aspergillosis. Voriconazole is the preferred treatment for invasive aspergillosis. When CNS aspergillosis emerges, it might be necessary to combine other systemic antifungal agents with intrathecal injection of amphotericin B.