Cerebral Aspergillus abscess in an immunecompetent patient: A case report

Abstract

Central nervous system (CNS) aspergillosis is a rare and highly fatal fungal disease, usually occurring in immunocompromised patients, with delayed diagnosis and difficult treatment. We describe a case of cerebral aspergillus abscess in a patient without apparent immunodeficiency. A 76-year-old man presented with progressive headache, fever, and lethargy for 2 months. Cranial CT showed abscesses in the left frontal, temporal, and parietal lobes and lateral ventricles, and chronic inflammation in the bilateral maxillary sinuses, left ethmoid sinus, and sphenoid sinus. Sphenoid sinus tissue revealed Aspergillus fumigatus on direct smear, culture, and histopathology. Voriconazole therapy was initiated immediately. Subsequent removal of multiple intracranial abscesses also confirmed A fumigatus. As one of the few reported cases of cerebral aspergillus abscess in an immunocompetent patient who achieved a favorable outcome after complete surgical resection and voriconazole therapy, this case offers new insights and proposes a framework for surveillance and clinical management. It underscores that aspergillus may invade the brain via the paranasal sinuses, and that early diagnosis together with urgent surgical intervention and antifungal therapy is crucial for reducing mortality.