RESUMEN
Fungal infections involving the pituitary gland are rare and can be life threatening. A 75-year-old man with hypertension and diabetes mellitus presented with headache and hyponatraemia. Imaging study showed right upper lung mass, and mass resection showed aspergilloma without tissue invasion on histology. The patient developed visual impairment a few weeks later, and MRI of the brain revealed bilateral sphenoid sinusitis and pituitary invasion. The trans-sphenoidal biopsy confirmed invasive Aspergillus infection. His sphenoidal sinuses were endoscopically debrided, and he was treated with oral voriconazole. Pituitary aspergillosis should be considered in the differential diagnosis in patients with lung aspergilloma with headache and sinusitis. Prompt biopsy and antifungal treatment are important due to the high mortality rate of the infection.
Asunto(s)
Síndrome de Secreción Inadecuada de ADH/diagnóstico , Neuroaspergilosis/diagnóstico , Enfermedades de la Hipófisis/diagnóstico , Aspergilosis Pulmonar/diagnóstico por imagen , Anciano , Antifúngicos/uso terapéutico , Complicaciones de la Diabetes , Diabetes Mellitus , Endoscopía , Cefalea/etiología , Hemoptisis/etiología , Humanos , Hipertensión , Hiponatremia/etiología , Hipopituitarismo/diagnóstico , Hipopituitarismo/etiología , Hipopituitarismo/metabolismo , Síndrome de Secreción Inadecuada de ADH/etiología , Síndrome de Secreción Inadecuada de ADH/metabolismo , Imagen por Resonancia Magnética , Masculino , Neuroaspergilosis/complicaciones , Neuroaspergilosis/tratamiento farmacológico , Neuroaspergilosis/metabolismo , Enfermedades de la Hipófisis/complicaciones , Enfermedades de la Hipófisis/tratamiento farmacológico , Enfermedades de la Hipófisis/metabolismo , Aspergilosis Pulmonar/complicaciones , Aspergilosis Pulmonar/cirugía , Insuficiencia Renal Crónica , Sinusitis del Esfenoides/complicaciones , Sinusitis del Esfenoides/diagnóstico , Sinusitis del Esfenoides/terapia , Cirugía Torácica Asistida por Video , Voriconazol/uso terapéuticoRESUMEN
INTRODUCTION: Rhino-orbital-aspergillosis (ROA) is a rare but serious disease in immunocompetent patients. Diagnosis is often delayed due to the absence of specific clinical symptoms. We describe the case of a patient who presented initially with ROA which spread progressively to the right ethmoid-sphenoid sinuses and then to the brain. OBSERVATION: A 61-year-old patient with a history of well-controlled diabetes presented with a sudden severe decrease in right visual acuity. Cerebral MRI showed the presence of an infiltrate in the right orbital apex extending to the homolateral cavernous sinus without any cerebral involvement. A diagnosis of right orbital myositis was made and corticosteroid therapy was started. His symptoms worsened progressively leading to quasi-blindness. A new MRI showed the development of right sphenoid-ethmoid osteolytic lesions. A fungal aetiology was suspected and tests for fungal biomarkers found a ß-(1-3)-D-glucan level of 99pg/ml but negative galactomannan. An ethmoid biopsy was performed for histological and mycological investigations, including the detection of Aspergillus DNA by qPCR. qPCR was positive and culture resulted in the isolation of multi-sensitive Aspergillus fumigatus. Treatment was initiated with voriconazole. Due to persistence of blindness and the appearance of a lesion extending to the right frontal lobe, surgical excision was performed followed by antifungal treatment for a total duration of 1year. The patient is currently stable, but has persistence of blindness in the right eye. CONCLUSION: Invasive ROA is a rare but serious disease in immunocompetent patients which should be evoked in the differential diagnosis of a tumour or vasculitis. Early diagnosis is essential for optimal management.
Asunto(s)
Aspergilosis/diagnóstico , Infecciones Fúngicas del Sistema Nervioso Central/diagnóstico , Infecciones Fúngicas del Ojo/microbiología , Inmunocompetencia , Infecciones Fúngicas Invasoras/diagnóstico , Rinitis/microbiología , Antifúngicos/uso terapéutico , Aspergilosis/tratamiento farmacológico , Aspergilosis/microbiología , Aspergillus fumigatus/aislamiento & purificación , Ceguera/diagnóstico , Ceguera/microbiología , Infecciones Fúngicas del Sistema Nervioso Central/complicaciones , Infecciones Fúngicas del Sistema Nervioso Central/tratamiento farmacológico , Infecciones Fúngicas del Sistema Nervioso Central/microbiología , Complicaciones de la Diabetes/tratamiento farmacológico , Complicaciones de la Diabetes/microbiología , Infecciones Fúngicas del Ojo/complicaciones , Infecciones Fúngicas del Ojo/diagnóstico , Infecciones Fúngicas del Ojo/tratamiento farmacológico , Humanos , Infecciones Fúngicas Invasoras/tratamiento farmacológico , Infecciones Fúngicas Invasoras/microbiología , Masculino , Persona de Mediana Edad , Neuroaspergilosis/complicaciones , Neuroaspergilosis/diagnóstico , Neuroaspergilosis/tratamiento farmacológico , Neuroaspergilosis/microbiología , Enfermedades Orbitales/diagnóstico , Enfermedades Orbitales/tratamiento farmacológico , Enfermedades Orbitales/microbiología , Rinitis/complicaciones , Rinitis/diagnóstico , Rinitis/tratamiento farmacológico , Voriconazol/uso terapéuticoRESUMEN
To describe a fatal case of invasive Aspergillus flavus sinusitis in a 43-year old female with sickle cell disease (SCD) complicated by intracerebral aspergilloma and invasive Salmonella infection. Cerebral aspergilloma carries a very high mortality rate. The patient developed post-craniotomy intracerebral hemorrhage at the site of biopsy, Salmonella species sepsis and ventriculitis. She presented with a 2-month history of headache, dizziness, personality and behavioral changes, and vomiting. Initial clinical evaluation raised the suspicion of brain tumor. Brain magnetic resonance imaging revealed a left frontal, thick-walled ring-enhancing lesion with extensive surrounding edema suggestive of a neoplastic lesion, or a contiguous inflammatory or infectious process from the skull base. Despite early diagnosis and appropriate antifungal and surgical management, she eventually died from severe infection and respiratory arrest. In conclusion, invasive aspergillosis should be included in the differential diagnosis of SCD patients with central nervous system (CNS) lesions.
Asunto(s)
Anemia de Células Falciformes/complicaciones , Aspergillus flavus/aislamiento & purificación , Bacteriemia/complicaciones , Encefalopatías/complicaciones , Ventriculitis Cerebral/complicaciones , Neuroaspergilosis/complicaciones , Enfermedades de los Senos Paranasales/complicaciones , Infecciones por Salmonella/complicaciones , Adulto , Antifúngicos/uso terapéutico , Aspergillus flavus/patogenicidad , Bacteriemia/microbiología , Encefalopatías/diagnóstico por imagen , Encefalopatías/tratamiento farmacológico , Ventriculitis Cerebral/diagnóstico por imagen , Ventriculitis Cerebral/tratamiento farmacológico , Craneotomía/efectos adversos , Diagnóstico Diferencial , Resultado Fatal , Femenino , Humanos , Imagen por Resonancia Magnética , Neuroaspergilosis/diagnóstico por imagen , Neuroaspergilosis/tratamiento farmacológico , Enfermedades de los Senos Paranasales/microbiología , Complicaciones Posoperatorias/microbiologíaRESUMEN
Resumen La aspergilosis cerebral es una patología infrecuente, pero de elevada mortalidad en pacientes con SIDA. Es importante considerarla entre los diagnósticos diferenciales ante una lesión expansiva cerebral. Se requiere un alto grado de sospecha para poder realizar un diagnóstico precoz. Se presenta el caso de un paciente con infección por VIH con un cuadro neurológico rápidamente progresivo por Aspergillus sección flavi. Se realiza una revisión de 40 casos publicados de aspergilosis cerebral en pacientes con SIDA.
Cerebral aspergillosis is a rare disease with high mortality rates in AIDS patients. It is important to take this into account in the differential diagnosis of a brain expansive lesion. A high level of suspicion is required to make an early diagnosis. We present a case of an HIV-infected patient with progresive neurological disease caused by Aspergillus flavi. We review 40 previously published cases of central nervous system aspergillosis in patients with AIDS.
Asunto(s)
Humanos , Masculino , Adulto , Encefalopatías/microbiología , Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Neuroaspergilosis/complicaciones , Encefalopatías/diagnóstico , Encefalopatías/inmunología , Imagen por Resonancia Magnética , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/inmunología , Resultado Fatal , Neuroaspergilosis/diagnóstico , Neuroaspergilosis/inmunología , Diagnóstico Diferencial , InmunocompetenciaRESUMEN
RATIONALE: Central nervous system (CNS) aspergillosis has the characteristics of multifocality, polymorphism, and coexistence of pathological types, and missed diagnosis and misdiagnosis frequently occur at the initial stage. The thesis reports a rare case of infant infection of CNS aspergillosis with the first-episode of intracranial hemorrhage. PATIENT CONCERNS: An 11-month-old female infant suffered convulsion and coma two days after the onset of fever and emesis. Its cranial computed tomography (CT) displayed subdural hemorrhage in the left tentorium cerebelli and tests indicated normal cerebrospinal fluid (CSF). Three days after being hospitalized, the infant had difficulty breathing and its CT presents consolidation in the right lung. However, treatment with ceftriaxone (ivgtt) had no effect on the baby. DIAGNOSIS: The patient's bronchoalveolar lavage fluid (BALF) was cultured into Aspergillus spp, its galactomannan (GM) antigen in CSF counted 3.0, higher than that in BALF which counted 2.6, and cranial magnetic resonance imaging (MRI) revealed multiple ring reinforced tubercles in sulci. Hence it was clinically diagnosed with CNS aspergillosis. INTERVENTIONS: Voriconazole for intravenous injection. After the intravenous injection, its trough concentration was 4.2 µg/mL, and it was within the recommended range. OUTCOMES: After one week's treatment with voriconazole, the infant's consciousness was improved. Four weeks later, with normothermia and clear consciousness, the patient was discharged. With oral administration of voriconazole up to 16 weeks, its physical state suggests no relapse and cranial MRI indicated disappearance of nodules in sulci. LESSONS: CNS aspergillosis with first-episode of intracranial hemorrhage probably leads to misdiagnosis and GM test combined with cranial MRI can augment its accuracy in the early diagnosis.
Asunto(s)
Infecciones Fúngicas del Sistema Nervioso Central/complicaciones , Hemorragias Intracraneales/parasitología , Neuroaspergilosis/complicaciones , Antifúngicos/administración & dosificación , Infecciones Fúngicas del Sistema Nervioso Central/tratamiento farmacológico , Humanos , Lactante , Neuroaspergilosis/tratamiento farmacológico , Voriconazol/administración & dosificaciónRESUMEN
Cerebral aspergillosis is a rare disease with high mortality rates in AIDS patients. It is important to take this into account in the differential diagnosis of a brain expansive lesion. A high level of suspicion is required to make an early diagnosis. We present a case of an HIV-infected patient with progresive neurological disease caused by Aspergillus flavi. We review 40 previously published cases of central nervous system aspergillosis in patients with AIDS.
Asunto(s)
Infecciones Oportunistas Relacionadas con el SIDA/microbiología , Encefalopatías/microbiología , Neuroaspergilosis/complicaciones , Infecciones Oportunistas Relacionadas con el SIDA/diagnóstico , Infecciones Oportunistas Relacionadas con el SIDA/inmunología , Adulto , Encefalopatías/diagnóstico , Encefalopatías/inmunología , Diagnóstico Diferencial , Resultado Fatal , Humanos , Inmunocompetencia , Imagen por Resonancia Magnética , Masculino , Neuroaspergilosis/diagnóstico , Neuroaspergilosis/inmunologíaRESUMEN
Invasive pulmonary aspergillosis (IPA) is a rare pathology with increasing incidence mainly in critical care settings and recently in immunocompetent patients. The mortality of the disease is very high, regardless of an early diagnosis and aggressive treatment. Here, we report a case of a 56 yr old previously healthy woman who was found unconscious at home and admitted to the emergency room with mild respiratory insufficiency. In the first 24 hours she developed an acute respiratory failure with new radiographic infiltrates requiring Intensive Care Unit admission. A severe obstructive pattern with impossibility of ventilation because of bilateral atelectasis was observed, requiring emergent venovenous extracorporeal membrane oxygenator device insertion. Bronchoscopy revealed occlusion of main bronchi, demonstrating by biopsy an invasive infection by Aspergillus fumigatus and A. flavus. Despite an aggressive treatment and vital support the patient had a fatal outcome. The forensic study confirms the diagnosis of IPA but also revealed the presence of disseminated aspergillosis.
Asunto(s)
Oxigenación por Membrana Extracorpórea , Inmunocompetencia , Aspergilosis Pulmonar Invasiva/diagnóstico , Insuficiencia Respiratoria/terapia , Antifúngicos/uso terapéutico , Aspergilosis/complicaciones , Aspergilosis/patología , Aspergillus flavus , Aspergillus fumigatus , Autopsia , Broncoscopía , Resultado Fatal , Femenino , Humanos , Aspergilosis Pulmonar Invasiva/complicaciones , Aspergilosis Pulmonar Invasiva/tratamiento farmacológico , Aspergilosis Pulmonar Invasiva/patología , Persona de Mediana Edad , Miocarditis/complicaciones , Miocarditis/patología , Nefritis/complicaciones , Nefritis/patología , Neuroaspergilosis/complicaciones , Neuroaspergilosis/patología , Radiografía Torácica , Insuficiencia Respiratoria/etiología , Tomografía Computarizada por Rayos XRESUMEN
Cerebral aspergillosis is associated with a significant morbidity and mortality rate. The imaging data present different patterns and no full consensus exists on typical imaging characteristics of the cerebral lesions. We reviewed MRI findings in 21 patients with cerebral aspergillosis and correlated them to the immune status of the patients and to neuropathological findings when tissue was available. The lesions were characterized by their number, topography, and MRI signal. Dissemination to the brain resulted from direct spread from paranasal sinuses in 8 patients, 6 of them being immunocompetent. Hematogenous dissemination was observed in 13 patients, all were immunosuppressed. In this later group we identified a total of 329 parenchymal abscesses involving the whole brain with a predilection for the corticomedullary junction. More than half the patients had a corpus callosum lesion. Hemorrhagic lesions accounted for 13% and contrast enhancement was observed in 61% of the lesions. Patients with hematogenous dissemination were younger (p = 0.003), had more intracranial lesions (p = 0.0004) and had a higher 12-week mortality rate (p = 0.046) than patients with direct spread from paranasal sinuses. Analysis of 12 aneurysms allowed us to highlight two distinct situations. In case of direct spread from the paranasal sinuses, aneurysms are saccular and located on the proximal artery portions, while the hematogenous dissemination in immunocompromised patients is more frequently associated with distal and fusiform aneurysms. MRI is the exam of choice for cerebral aspergillosis. Number and type of lesions are different according to the mode of dissemination of the infection.
Asunto(s)
Encefalopatías/diagnóstico , Encefalopatías/patología , Imagen por Resonancia Magnética , Neuroaspergilosis/diagnóstico , Neuroaspergilosis/patología , Adulto , Anciano , Encefalopatías/complicaciones , Encefalopatías/inmunología , Humanos , Masculino , Persona de Mediana Edad , Neuroaspergilosis/complicaciones , Neuroaspergilosis/inmunología , Senos Paranasales/microbiología , Pronóstico , Estudios Retrospectivos , Enfermedades Vasculares/complicacionesRESUMEN
Invasive aspergillosis (IA) is a severe disseminated fungal disease that occurs mostly in immunocompromised patients. However, central nervous system IA, combining meningitis and skull base involvement, does not occur only in groups with classic risk factors for IA; patients with chronic renal failure and diabetes mellitus are also at risk for more chronic forms. In both of our proven IA cases, voriconazole monotherapy was effective without surgery, and cerebrospinal fluid and serum 1,3-ß-d-glucan test results were initially positive, in contrast to galactomannan antigen results.
Asunto(s)
Antifúngicos/uso terapéutico , Meningitis Fúngica/tratamiento farmacológico , Neuroaspergilosis/tratamiento farmacológico , Otitis/tratamiento farmacológico , Sinusitis/tratamiento farmacológico , Voriconazol/uso terapéutico , Anciano , Aspergillus flavus/efectos de los fármacos , Aspergillus flavus/crecimiento & desarrollo , Aspergillus flavus/patogenicidad , Aspergillus fumigatus/efectos de los fármacos , Aspergillus fumigatus/crecimiento & desarrollo , Aspergillus fumigatus/patogenicidad , Candida albicans/efectos de los fármacos , Candida albicans/crecimiento & desarrollo , Candida albicans/patogenicidad , Enfermedad Crónica , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/tratamiento farmacológico , Diabetes Mellitus Tipo 2/microbiología , Femenino , Humanos , Meningitis Fúngica/complicaciones , Meningitis Fúngica/diagnóstico , Meningitis Fúngica/microbiología , Neuroaspergilosis/complicaciones , Neuroaspergilosis/diagnóstico , Neuroaspergilosis/microbiología , Otitis/complicaciones , Otitis/diagnóstico , Otitis/microbiología , Insuficiencia Renal Crónica/complicaciones , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/tratamiento farmacológico , Insuficiencia Renal Crónica/microbiología , Sinusitis/complicaciones , Sinusitis/diagnóstico , Sinusitis/microbiología , Resultado del Tratamiento , beta-Glucanos/sangre , beta-Glucanos/líquido cefalorraquídeoAsunto(s)
Encéfalo/patología , Complicaciones de la Diabetes/patología , Encefalitis Infecciosa/complicaciones , Encefalitis Infecciosa/patología , Neuroaspergilosis/complicaciones , Neuroaspergilosis/patología , Resultado Fatal , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Tomografía Computarizada por Rayos XRESUMEN
OBJECT: Tumor necrosis factor (TNF)-α inhibitors are effective at treating certain inflammatory and autoimmune disorders. They are generally safe; potential adverse events include infections (bacterial, fungal, and viral), congestive heart failure exacerbations, and the potential for demyelinating diseases and possibly certain malignancies. We present the first documented case of fungal internal carotid artery (ICA) mycotic aneurysm in a patient being treated with a TNF-α inhibitor. We also review the literature on infections with TNF-α inhibition and the management of previously reported fungal ICA mycotic aneurysm cases. CASE DESCRIPTION: A 76-year-old woman with rheumatoid arthritis, treated with etanercept and methotrexate, presented with a 2-week history of left temporal headaches. She was treated empirically for giant cell arteritis (GCA) with oral prednisone, which provided no symptom relief. She was subsequently hospitalized for a superficial temporal artery biopsy, which was negative for GCA. She returned 2 weeks later after experiencing a left thromboembolic ischemic stroke. She had an acute neurologic decline, and a head computed tomography scan showed diffuse subarachnoid hemorrhage from a ruptured left fusiform paraclinoid ICA aneurysm. She was taken emergently for a craniotomy for clip-wrapping of the aneurysm, but intraoperative ultrasound revealed poor flow in the left anterior cerebral circulation and a complete infarct of the left-sided anterior circulation. The family withdrew care and the patient died. Postmortem analysis demonstrated fungi consistent with Aspergillus invading the necrotic left ICA. CONCLUSIONS: Although fungal mycotic aneurysms of the ICA are rare, their incidence may increase with the expanded use of immunosuppressive medications. Patients with rheumatoid arthritis who take potent immunosuppression regimens may be prime candidates for mycotic aneurysms because they often have two favoring conditions: atherosclerosis and immunosuppression. These ICA aneurysms carry a high mortality rate, so early diagnosis and aggressive therapy, potentially by endovascular trapping/vessel occlusion coupled with long-term antifungal therapy, is essential.
Asunto(s)
Aneurisma Roto/etiología , Antirreumáticos/efectos adversos , Enfermedades de las Arterias Carótidas/etiología , Arteria Carótida Interna/patología , Neuroaspergilosis/complicaciones , Fiebre Reumática/tratamiento farmacológico , Factor de Necrosis Tumoral alfa/antagonistas & inhibidores , Anciano , Aneurisma Roto/microbiología , Enfermedades de las Arterias Carótidas/microbiología , Arteria Carótida Interna/microbiología , Etanercept/efectos adversos , Femenino , Humanos , Metotrexato/efectos adversosRESUMEN
Cerebral aspergillosis is a rare and highly fatal hematogenous infection most commonly found in immune compromised patients. From the onset of neurologic symptoms, the median reported rate of survival is between 5 and 9 days. Compounded with increased hemorrhagic risks and the lack of specificity in both clinical presentation and traditional imaging, a fast and noninvasive method of definitive diagnosis is necessary if there is to be any hope for positive outcomes. We describe the case of a 50-year-old female diabetic with a history of otitis media, an uncharacterized inflammatory nasopharyngeal process, and prior ischemic strokes who presented with a new cerebral infarction in the setting of an angioinvasive fungal infection of the large cerebral arteries. We also present a literature review of aspergillosis detection and treatment in hopes that future cases will be diagnosed in a timely manner and more patients may be saved.
Asunto(s)
Encefalopatías/complicaciones , Isquemia Encefálica/etiología , Diabetes Mellitus Tipo 2/complicaciones , Neuroaspergilosis/complicaciones , Accidente Cerebrovascular/etiología , Encefalopatías/patología , Isquemia Encefálica/patología , Diabetes Mellitus Tipo 2/patología , Resultado Fatal , Femenino , Humanos , Persona de Mediana Edad , Neuroaspergilosis/patología , Accidente Cerebrovascular/patologíaRESUMEN
BACKGROUND: Opportunistic fungi are dispersed as airborne, ground and decaying matter. The second most frequent extra-pulmonary disease by Aspergillus is in the central nervous system. CASE PRESENTATION: The case subject was 55 years old, male, mulatto, and an assistant surveyor residing in Teresina, Piauí. He presented with headache, seizures, confusion, fever and left hemiparesis upon hospitalization in 2006 at Hospital São Marcos. Five years previously, he was diagnosed with diabetes mellitus, and 17 months previously he had acne margined by hyperpigmented areas and was diagnosed with leprosy. Laboratory tests indicated leukocytosis and magnetic resonance imaging showed an infarction in the right cerebral hemisphere. Cerebrospinal fluid examination showed 120 cells/mm(3) and was alcohol-resistant bacilli negative. Trans-sphenoidal surgery with biopsy showed inflammation was caused by infection with Aspergillus fumigatus. We initiated use of parenteral amphotericin B, but his condition worsened. He underwent another surgery to implant a reservoir of Ommaya-Hickmann, a subcutaneous catheter. We started liposomal amphotericin B 5 mg/kg in the reservoir on alternate days. He was discharged with a prescription of tegretol and fluconazole. CONCLUSION: This report has scientific interest because of the occurrence of angioinvasive cerebral aspergillosis in a diabetic patient, which is rarely reported. In conclusion, we suggest a definitive diagnosis of cerebral aspergillosis should not postpone quick effective treatment.
Asunto(s)
Aspergillus fumigatus/patogenicidad , Cerebro/microbiología , Diabetes Mellitus , Lepra Lepromatosa/complicaciones , Neuroaspergilosis/microbiología , Anfotericina B/administración & dosificación , Anticonvulsivantes/uso terapéutico , Antifúngicos/administración & dosificación , Aspergillus fumigatus/aislamiento & purificación , Biopsia , Carbamazepina/uso terapéutico , Diabetes Mellitus/diagnóstico , Fluconazol/administración & dosificación , Humanos , Lepra Lepromatosa/diagnóstico , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Neuroaspergilosis/complicaciones , Neuroaspergilosis/diagnóstico , Neuroaspergilosis/tratamiento farmacológico , Valor Predictivo de las Pruebas , Convulsiones/tratamiento farmacológico , Convulsiones/etiología , Resultado del TratamientoRESUMEN
We report a case of cerebral aspergilloma in a 25-year-old immunoincompetent man admitted to a general intensive care unit. Monitoring of intracranial pressure was instigated and revealed hour-long epochs of severe intracranial hypertension, despite a normal opening pressure, with decreases in cerebral perfusion pressure. We documented that this was associated with cerebral hypoperfusion by transcranial Doppler ultrasound. The present case illustrates that severe intracranial hypertension may evolve despite a normal opening pressure; it furthermore shows that continuous monitoring of intracranial pressure may be used to predict changes in cerebral haemodynamics in critically ill patients with neuroinfection.
Asunto(s)
Isquemia Encefálica/diagnóstico por imagen , Circulación Cerebrovascular , Huésped Inmunocomprometido , Hipertensión Intracraneal/diagnóstico , Leucemia Prolinfocítica de Células T/inmunología , Micetoma/inmunología , Neuroaspergilosis/inmunología , Adulto , Isquemia Encefálica/etiología , Resultado Fatal , Humanos , Hipertensión Intracraneal/etiología , Masculino , Monitoreo Fisiológico , Micetoma/complicaciones , Neuroaspergilosis/complicaciones , Ultrasonografía Doppler TranscranealRESUMEN
The authors report a case of invasive aspergillosis of a sphenoid sinus mucocele revealed in a patient with diabetes in Djibouti by homolateral palsy of the 3rd, 4th, 5th and 6th nerves. This rare condition occurs preferentially in immunodeficient subjects. Because of its clinical polymorphism, its diagnosis is difficult and is often not made until complications develop. Endonasal surgery with anatomopathological and mycological examination is both a diagnostic and therapeutic procedure. It must be performed early, to avoid functional or even life-threatening complications.
Asunto(s)
Enfermedades de los Nervios Craneales/microbiología , Neuroaspergilosis/complicaciones , Seno Esfenoidal , Djibouti , Humanos , Masculino , Persona de Mediana EdadRESUMEN
Common variable immunodeficiency (CVID) is the most common primary immune defect, resulting in hypogammaglobulinemia as well as deficits in cell-mediated immunity. Although it mainly manifests in immunodeficiency and related infection, CVID can also be associated with autoimmune phenomena such as immune thrombocytopenic purpura, hemolytic anemia, rheumatoid arthritis, lupus, primary biliary cirrhosis, and autoimmune hepatitis (AIH). AIH is a less common but serious complication of CVID, which can result in early cirrhosis, ascites, and even hepatocellular carcinoma. Here, we discuss a recent case of transplantation for cirrhosis secondary to AIH in the context of CVID. Although the patient's surgery occurred without complication, he rapidly developed fulminant alveolar hemorrhage and seizures, and died secondary to disseminated neuroaspergillosis.