Case Report


Aspergillus brain abscess presents as sinusitis in immunosuppressed and hyperglycemic patient

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1 Medical Student at Medical College of Wisconsin, Milwaukee, Wisconsin, USA

2 Graduate of Drake University, Biochemistry, Cell & Molecular Biology, Chemistry, Des Moines, Iowa, USA

3 Associate Professor, Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

4 Assistant Professor, Internal Medicine, Medical College of Wisconsin, Milwaukee, Wisconsin, USA

Address correspondence to:

Sarah C Kurkowski

4359 S 110th Street, Greenfield, WI 53228,

USA

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Article ID: 100069Z09SK2022

doi: 10.5348/100069Z09SK2022CR

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How to cite this article

Kurkowski SC, Thimmesch MJ, Jha P, Abdelgadir YH. Aspergillus brain abscess presents as sinusitis in immunosuppressed and hyperglycemic patient. J Case Rep Images Med 2022;8(1):13–18.

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.

Keywords: Aspergillus brain abscess, Aspergillus fumigatus, Aspergillus sinusitis, Immunocompromised

SUPPORTING INFORMATION


Author Contributions

Sarah C Kurkowski - Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Michael J Thimmesch - Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published

Pinky Jha - Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published

Yasir H Abdelgadir - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published

Guaranter of Submission

The corresponding author is the guarantor of submission.

Source of Support

None

Consent Statement

Written informed consent was obtained from the patient for publication of this article.

Data Availability

All relevant data are within the paper and its Supporting Information files.

Conflict of Interest

Authors declare no conflict of interest.

Copyright

© 2022 Sarah C Kurkowski et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.