Two Cases of Isolated Intracranial Aspergilloma Mimicking Convexity and Skull Base Meningioma: Diagnostic and...

Intracranial aspergilloma is a rare fungal infection of the central nervous system, predominantly affecting immunocompromised individuals. However, cases in immunocompetent hosts are increasingly reported, often mimicking meningiomas due to similar radiological features, leading to diagnostic delays and poor outcomes.

We present two cases of isolated intracranial aspergilloma in immunocompetent patients. The first case involved a 55-year-old female with a right parietal scalp swelling mimicking a convexity meningioma, confirmed as aspergilloma on histopathology following surgical excision. The second case was a 63-year-old male with symptoms of raised intracranial pressure and a right planum sphenoidale lesion mimicking skull base meningioma, also diagnosed postoperatively as invasive aspergillosis. Both patients underwent surgical resection and voriconazole therapy, with favorable short-term outcomes. These cases highlight the diagnostic challenges posed by overlapping imaging characteristics of aspergilloma and meningioma.

A high index of suspicion, even in immunocompetent patients, is essential for timely histopathological confirmation and antifungal treatment to mitigate morbidity and mortality. Adding aspergilloma to the differential diagnosis of meningioma-like lesions on radiology may improve outcomes.