Otogenic Aspergillus Brain Abscess in an SLE teen: Successful case management from Eastern India

Neuroaspergillosis is a rare, high-mortality complication in Systemic Lupus Erythematosus (SLE). We report an otogenic Aspergillus fumigatus brain abscess in a 17-year-old female with SLE and seizure disorder, managed with immunosuppressants. She presented with altered sensorium and hemiparesis. Despite initial aspiration and combination antifungal therapy (voriconazole and liposomal amphotericin B), clinical worsening demanding radical excision. Culture and sequencing confirmed A. fumigatus, likely spread via chronic otitis media. The patient recovered and was discharged on oral posaconazole, remaining healthy at two-month follow-up. This case underscores the risk of otogenic fungal spread in SLE and demonstrates that timely neurosurgical intervention combined with prolonged antifungal therapy can ensure survival in otherwise lethal cerebral aspergillosis.