Neuroaspergillosis in an immunocompetent patient successfully treated with voriconazole and a corticosteroid

Intern Med. 2009;48(14):1225-9. doi: 10.2169/internalmedicine.48.2165. Epub 2009 Jul 15.

Abstract

Aspergillosis of the central nervous system (CNS) is an uncommon infection, mainly occurring in immunocompromised patients. We report a case of nasocerebral aspergillosis in an immunocompetent patient successfully treated with voriconazole and a corticosteroid. Magnetic resonance imaging (MRI) showed contrast enhancement surrounding the brainstem and cerebellum with intramedullary pontine and cerebellar T2-hyperintense lesions. The patient's symptoms and MRI abnormalities improved after voriconazole and corticosteroid treatment; however, discontinuation of the corticosteroid caused a worsening of the T2-hyperintense lesions, whereas resuming it resulted in its improvement. This suggested that these T2-hyperintense lesions may be due to secondary inflammation caused by aspergillosis and not the aspergillosis itself. We conclude that treatment with a combination of voriconazole and a corticosteroid appears to be effective for the treatment of some patients with CNS aspergillosis.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Antifungal Agents / therapeutic use*
  • Brain Diseases / drug therapy*
  • Brain Diseases / microbiology*
  • Humans
  • Immunocompetence
  • Male
  • Neuroaspergillosis / drug therapy*
  • Pyrimidines / therapeutic use*
  • Remission Induction
  • Triazoles / therapeutic use*
  • Voriconazole

Substances

  • Antifungal Agents
  • Pyrimidines
  • Triazoles
  • Voriconazole