Cerebral Aspergillosis on autopsy; masquerading clinically as Brain tumor in a young female

Abstract

Cerebral aspergillosis is a rare pathology with fatal outcome. It is mostly a post-mortem diagnosis because the initial symptoms are mostly nonspecific and the existing diagnostic modalities are not sensitive to ensure early and definite diagnosis. The clinical manifestations and disease severity are dictated by the immunologic state of the patient. Cerebral aspergillosis can mimic tuberculous meningitis, pyogenic abscess, or brain tumor. Maxillary sinusitis of dental origin or the lungs are the most common sites of primary aspergillus infection. Infection reaches the brain directly from the nasal sinuses via vascular channels or is blood borne from the lungs and gastrointestinal tract. Dissemination of aspergillus is relatively common, with the central nervous system (CNS) being one of the most frequent sites of Invasive aspergillosis (IA) after the lungs. Aspergillosis should be considered in cases manifesting with acute onset of focal neurologic deficits resulting from a suspected vascular or space occupying lesion especially in immunocompromised hosts. Only a high index of suspicion, an aggressive approach to diagnosis, and rapid vigorous therapy can alter the clinical course in this group of patients.