Central nervous system aspergillosis in a child with medulloblastoma

Area of Science:

• Pediatric Oncology
• Infectious Diseases
• Neurology

Background:

• Cerebral aspergillosis is a rare but severe complication in immunocompromised patients, particularly in pediatric neuro-oncology.
• Children undergoing intensive chemotherapy for brain tumors face increased risks of opportunistic infections.
• Early diagnosis and treatment are crucial but challenging due to non-specific symptoms.

Purpose of the Study:

• To describe a rare case of cerebral aspergillosis in a pediatric neuro-oncology patient.
• To review previously reported cases of this complication.
• To highlight diagnostic difficulties and clinical presentation.

Main Methods:

• Case report of a child with high-risk medulloblastoma.
• Literature review of published cases of cerebral aspergillosis in pediatric neuro-oncology.
• Clinical data analysis including symptoms, diagnostic workup, treatment, and autopsy findings.

Main Results:

• The patient presented with febrile neutropenia, headache, and cerebrospinal fluid (CSF) pleocytosis, initially suspected as meningitis.
• Cerebral MRI showed ischemic lesions suggestive of vasculitis, but blood and CSF cultures were negative.
• Despite treatment with antibiotics, methylprednisolone, and amphotericin B, the patient experienced neurological deterioration and death, confirmed by autopsy showing cerebral aspergillosis.

Conclusions:

• Cerebral aspergillosis is a devastating complication in pediatric neuro-oncology patients, often presenting with nonspecific symptoms.
• Diagnostic challenges include negative initial cultures and overlapping symptoms with other conditions like meningitis or vasculitis.
• Prompt recognition and aggressive antifungal therapy are essential, though outcomes remain poor in advanced stages.