Teaching NeuroImages: Aspergillosis-induced vasculitis presenting as ischemic stroke in an immunocompetent patient¶
Summary¶
- 56yo M
- c/c
- febrile
- Rt hemiplegia
- HPI
- –2mo
- surgery for pansinusitis (Aspergillus fumigatus)
- –2mo
- Ex
- MRI
- infarction
- Lt lentiform & caudate nuc
- Lt internal carotid & MCA stenosis
- infiltrative mass
- infarction
- CSF analysis
- lymphocytic meningitis
- β-D-glucans 190pg/mL
- MRI
- Dx
- Cerebral aspergillosis-related vasculitis
Further¶
Terminology¶
- immunocompetent: 正常な免疫反応を持っている
- pansinusitis: 汎副鼻腔炎
- Aspergillus fumigatus:
- voriconazole:
- caspofungin:
- liposomal amphotericin B:
- cerebral aspergillosis-related vasculitis:
Original¶
A 56-year-old immunocompetent man had surgery for pansinusitis; culture grew Aspergillus fumigatus. Two months later, he suddenly experienced febrile right-sided hemiplegia. Brain MRI revealed a recent infarction of the left lentiform and caudate nucleus (figure, A) with left internal carotid and middle cerebral arteries stenosis (figure, B) caused by a perivascular infiltrative mass (figure, C). CSF analysis revealed lymphocytic meningitis and β-D-glucans levels of 190 pg/mL (negative in serum). MRI worsened despite voriconazole followed by voriconazole/caspofungin (figure, D) but improved with caspofungin and liposomal amphotericin B during 15 months (figure, E). Cerebral aspergillosis-related vasculitis has been rarely reported.1,2
Figure¶
Acute ischemia secondary to internal carotid stenosis caused by a perivascular infiltrative enhancing mass
(A) Acute ischemia on diffusion-weighted imaging in the left lentiform and caudate nucleus.
(B) Time-of-flight magnetic resonance angiography: high-grade stenosis of the internal carotid with subsequent low flow. (C–E) Postcontrast T1-weighted MRI: perivascular infiltrative enhancing mass (C) at diagnosis and after (D) 7 and (E) 15 months of therapy.
References¶
- Marzolf G, Sabou M, Lannes B, et al. Magnetic resonance imaging of cerebral aspergillosis: imaging and pathological correlations. PLoS One 2016;11:e0152475.
- Norlinah MI, Ngow HA, Hamidon BB. Angioinvasive cerebral aspergillosis presenting as acute ischaemic stroke in a patient with diabetes mellitus. Singapore Med J 2007;48:e1–e4.