Aspergillus flavus-Induced Brain Abscess in an Immunocompetent Child: Case report

Abstract

Intracranial aspergillosis is an extremely rare manifestation of invasive aspergillosis in immunocompetent children and is associated with high morbidity and mortality. We report a 12-year-old immunocompetent male child who was referred to the King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia, in May 2010 after a sudden-onset headache and loss of consciousness. Brain imaging revealed a large right space-occupying occipital lesion and the patient underwent a craniotomy and resection. Histopathology of the lesion revealed necrotising granulomatous fungal encephalitis with many hyphae engulfed by multinucleated giant histiocytes. Two days later, a computed tomography scan showed debulking of the fungal mass and the patient was discharged on oral voriconazole. However, imaging at a six-week follow-up showed progression of the abnormality. A residual or persistent fungal brain lesion was suspected. Further neurosurgical resection of the lesion was performed and cultures showed growth of Aspergillus flavus. The patient was treated successfully with antifungal therapy over the following two years.

Keywords: Antifungal Agents; Aspergillus flavus; Brain Abscess; Case Report; Fungus Disease; Immunocompetence; Saudi Arabia.

Figure 1A&B:

A: Magnetic resonance imaging of the brain of a 12-year-old immunocompetent child showing a large right occipital mass (arrow) with heterogeneous enhancement, perifocal oedema in the right temporal and parietal lobes and a midline shift to the left. The nasal sinuses were clear. B: Post-resection computed tomography showing debulking of the right-sided occipital fungal mass (arrow) two days later. Note the regression of the perilesional reactive changes with a persistent mild midline shift to the left and regression of the right trigone effacement.

Figure 2A&B:

A: Magnetic resonance imaging (MRI) of the brain of a 12-year-old immunocompetent child six weeks after an initial resection of a right occipital fungal mass showing progression of the dense solid marginal tissue abnormality (arrow) and enhancement consistent with a granulomatous tissue abnormality. B: Brain MRI one month after the second resection showing partial resolution of the solid parenchymal abnormality (arrow).