A Case of Fatal Multiple Cerebral Aspergillosis in a Patient with Acute Promyelocytic Leukemia during Complete Remission

ABSTRACT

Cerebral aspergillosis accounts for about 10% of all the cases of invasive aspergillosis. The brain is the only infected site in less than 10% of cases. The patients at high risk for of aspergillosis are immunocompromised patients such as those in a neutropenic state after chemotherapy, AIDS and etc. We experienced a case of cerebral aspergillosis in a patient with acute leukemia that was in complete remission. The patient visited our hospital's ER due to nasal bleeding, and then he was quickly diagnosed as having acute promyelocytic leukemia. After the first induction chemotherapy, he achieved a complete remission. Loss of consciousness developed on day 31 after chemotherapy. High signal intensity in the right temporooccipital lobe and multiple nodular lesions in both cerebral hemispheres were observed on the brain MRI. Stereotaxic biopsy showed septate aspergillus hyphae in the brain specimen. Despite of the use of amphotericin B deoxycholate, the patient died of recurrent grand mal seizure and multiple organ failure.