MR features of cerebral aspergillosis in an immunocompetent patient: correlation with histology and elemental analysis

Abstract

We report an unusual case of cerebral aspergillosis in a young immunocompetent patient who also had dissemination to other end organs. The patient presented with a large mass in the left cerebral hemisphere. Elemental analysis of biopsy specimens revealed elevated levels of iron, magnesium, zinc, calcium, chromium, and nickel that correlated with a peripheral rim of hypointensity on T2-weighted images.

Fig 1.

CT scan of the brain. Axial precontrast scan shows a large, isoattenuated left temporoparieto-occipital mass with central hypoattenuated areas of necrosis and one focal calcification.

Fig 2.

Brain MR imaging. A, Sagittal T1-weighted image shows the extent of the large mass, which is mostly isointense to gray matter with a mildly hyperintense perimeter. B, Axial T2-weighted image demonstrates the hypointense wall of the mass with surrounding brain edema. Thin, interrupted, low signal intensity zones (arrows) line the margin between the outer wall and central hyperintense necrotic area. C, Axial contrast-enhanced study reveals a thick, irregular enhancing rim. The low signal intensity zones (arrows) do not enhance.

Fig 3.

Histopathologic findings. A, Methanamin silver stain (magnification ×200) shows dichotomous branching, septated fungi (arrows). B, Hematoxylin and eosin stain (magnification ×200) reveals granulomas with epithelioid histiocytes and multinucleated giant cells (arrows). C, Perl stain (magnification ×200) shows blue color staining of iron material (arrows).