Aspergillus brain abscess presents as sinusitis in immunosuppressed and hyperglycemic patient

Abstract

Introduction: There are currently very few documented case reports of Aspergillus brain abscesses in the setting of persistent sinusitis symptoms and comorbid conditions of Type II Diabetes Mellitus and steroid treatment. Many cases of intracranial aspergillosis are secondary to a disseminated invasive Aspergillus infection or primary pulmonary aspergillosis. This case illustrates the importance and vitality of considering the rare but potentially lethal diagnosis of Aspergillus fumigatus brain abscess in the differential of persistent sinusitis, even in the absence of systemic symptoms. Case Report: A 73-year-old female with risk factors of Type II Diabetes Mellitus (T2DM) and steroid treatment presented to the hospital with persistent sinusitis symptoms lasting three months. She subsequently was diagnosed with Aspergillus brain abscess after bicoronal bifrontal craniotomy with pericranial flap. The patient was treated with voriconazole and amphotericin B for 3–6 months post-resection and follow-up with neurosurgery to monitor abscess reduction. She was admitted five more times after initial diagnosis for sequelae related to the brain abscess. The initial abscess did decrease in size but then began to worsen. The patient unfortunately passed away six months after initial presentation and diagnosis. Conclusion: Few cases of invasive rhino-orbito-cerebral Aspergillus brain abscesses secondary to Aspergillus sinus infections have been documented. If missed it can be lethal. Therefore, when a patient presents with persistent sinusitis, in the relevant context, Aspergillus brain abscesses are an important differential diagnosis that warrant consideration.