Locally Invasive Central Nervous System Aspergillosis Presenting as Subacute Vision Loss

Aspergillus is a ubiquitous environmental fungus that has the potential to cause a wide array of clinical illnesses, from an allergic response to invasive disseminated disease - particularly in those with immune dysfunction or underlying disease.

An 83-year-old immunocompromised man presented to the emergency department with fever and subacute vision loss over 3 to 4 months after multiple prior emergency department and outpatient ophthalmology visits. After a complicated course, locally invasive central nervous system aspergillosis was diagnosed. Although the patient eventually recovered, he experienced permanent vision loss.

This case demonstrates the importance of aggressive workup in immunosuppressed patients with onset of any concerning ocular or other symptoms. A multidisciplinary approach is necessary for optimal patient outcomes.

Aspergillosis has the potential to cause devastating disease and long-term consequences in immunocompromised patients. Clinicians should be alerted to the importance of early detection and intervention for this population.