Intracranial aspergillosis in immunocompetent adult patients without risk factors: a systematic review

The Potential Diagnostic Trap of Unexpected Intracranial Hyalohyplymycosis-A Case Report and Brief Literature Review

Background: Intracranial fungal infection represents a rare entity, especially in immunocompetent patients. The available neuroimaging methods may show nonspecific results; thus, a final diagnosis is based on histopathological examination. Methods: This report aims to describe a rare case of a young immunocompetent adult who developed a secondary skull base infection, probably due to primary sinonasal involvement. The patient was an 18-year-old immunocompetent male adult with intracranial hyalohyphomycosis, diagnosed and neurosurgically treated in the 3rd Neurosurgical Department of Clinical Emergency Hospital Bagdasar-Arseni. Results: The neurosurgical excision and intense antifungal therapy led to very good outcomes. The particularity of this case is highlighted by the local traumatic component due to boxing practice. The impact of presented cases of this kind is significant given the scarce information regarding this subject, and it can contribute to a better understanding of the underlying mechanisms of this pathology. Intracranial fungal infections are very rare and very often difficult to diagnose. Although it is known that their prognosis implies a mortality of up to 60% in immunocompromised patients, in immunocompetent cases, the exact characteristics of the disease, as well as the prognostic factors, are yet to be elucidated. Conclusions: The neuroimaging results are nonspecific in many cases, but a diagnosis is based on the histopathological results with specific features. Even though antifungal therapy is the main treatment for fungal infections, in cases of intracranial lesions, a diagnosis may be obtained after neurosurgical excision, and drug therapy will come second.

Aspergillus fumigatus Epidural Abscess and Postsurgical Wound Infection in an Immunocompetent Host

In this case, we present an immunocompetent patient who had a wound infection secondary to Aspergillus fumigatus after undergoing a neurosurgical procedure that was complicated by an epidural abscess. The patient was treated with voriconazole and responded favorably. We highlight the need for awareness of the possibility of an Aspergillus infection in people without any obvious immunocompromise and advocate for the inclusion of this opportunistic fungus in the workup of postneurosurgical infections and dura-based collections. A brief review of relevant literature is also included.

Sphenoid Sinus Aspergilloma in an Immunocompetent and an Immunocompromised Patient: A Case Report

Sellar, supra-sellar aspergilloma are rare differentials for a sellar mass. CNS aspergilloma occurs due to intracranial extension of invasive fungal sinusitis, and often first manifests with symptoms of headache and visual disturbance. This complication is much more common in immunocompromised patients, but proliferation of fungal pathogens and low index for suspicion has led to more severe breakthrough cases in the immunocompetent. If treated timely, these CNS lesions can have a relatively good prognosis. Conversely, delays in diagnosis can confer very high rates of mortality among patients with invasive fungal disease. Originally from India, in this case report, we describe two patients presenting with sellar, supra-sellar tumors, who eventually were diagnosed with confirmed cases of invasive intracranial aspergilloma. We describe the clinical presentation, imaging techniques, and treatment modalities for this relatively rare disease in both the immunocompromised and the immunocompetent.