Probable disseminated cerebral aspergillosis: recovery with medical treatment

Area of Science:

• Mycology
• Pediatric Oncology
• Infectious Diseases

Background:

• Cerebral aspergillosis is a rare but devastating complication in immunocompromised individuals, often with a fatal outcome.
• Acute lymphoblastic leukemia (ALL) patients undergoing intensive chemotherapy are particularly susceptible to invasive fungal infections.
• Standard treatment protocols for cerebral aspergillosis have limited success, especially in cases with disseminated disease.

Observation:

• A pediatric patient with acute lymphoblastic leukemia developed pulmonary aspergillosis with subsequent central nervous system (CNS) dissemination.
• Multifocal cerebral lesions precluded surgical intervention.
• The patient experienced a neutropenic relapse with reactivation of cerebral lesions despite modified anti-leukemic therapy.

Findings:

• A prolonged, combination antifungal regimen (amphotericin B, flucytosine, itraconazole) for 9 months was administered.
• The patient achieved complete remission and remained free of neurological sequelae seven years post-treatment.
• Successful management was achieved without surgical resection of aspergillomas.

Implications:

• Aggressive, long-term combination antifungal therapy is a viable treatment strategy for cerebral aspergillosis in immunocompromised hosts.
• Careful monitoring and adaptation of anti-leukemic therapy are essential to manage neutropenia and prevent fungal reactivation.
• Early diagnosis and prompt initiation of multimodal treatment can significantly improve the prognosis of cerebral aspergillosis.