CNS aspergillosis with mycotic aneurysm, cerebral granuloma and infarction

Summary

We are reporting a case of an immunocompromised patient with invasive aspergillosis (IA) who developed aspergillotic granulomas and a mycotic aneurysm of the superior cerebellar artery. The route of infection of the central nervous system (CNS) was hematogenous spread from a pulmonary focus. IA was detected with the Galactomannan (GM) technique. However, despite treatment with amphotericin B, progressive involvement of the vessel wall occurred causing fatal subarachnoid hemorrhage and massive brainstem and cerebellar infarction.

This case provides pathologic-imaging correlation of one of the most devastating types of fungal involvement affecting the CNS with a fungal aneurysm. Finally the literature regarding the pathogenetic, and diagnostic investigations and the management of CNS aspergillosis is reviewed.