Istiaq Mian, MD; Sam Ives, MD; Garry Jean-Louis, MD; Andrew Laczniak, MD
Published online ahead of print January 27, 2021.
Introduction: Aspergillus species are ubiquitous fungi that may cause invasive infection, particularly in immunocompromised patients. Invasive aspergillosis most commonly affects the lungs but can also disseminate to the central nervous system (CNS). Manifestations of CNS aspergillosis include abscesses and, rarely, mycotic aneurysm leading to subarachnoid hemorrhage (SAH).
Case Presentation: A 48-year-old man undergoing treatment for squamous cell cancer of the larynx with chemotherapy and steroids presented with dysarthria and weakness. He was found to have both lung and CNS infection secondary to Aspergillus species. While receiving intravenous antifungal treatment after biopsy-proven Aspergillus infection, he developed a fatal SAH caused by a mycotic aneurysm.
Discussion: Intracranial mycotic aneurysms are uncommon. However, mycotic aneurysm leading to a fatal SAH is a well-documented sequela of CNS aspergillosis. Mortality rates for CNS aspergillosis are extremely high.
Conclusion: In immunosuppressed patients with neutropenia or using chronic steroids who have concurrent pulmonary and CNS infection, there should be a low threshold to treat empirically for fungal infections prior to confirmation of diagnosis.