Neuroaspergillosis: A rare but devastating fungal infection

Fungal infection of the central nervous system is very uncommon and has devastating consequences that requires surgical excision in majority of cases. They pose significant diagnostic as well as therapeutic challenge. Aspergillosis is a fungal infection caused by fungi of the genus Aspergillus. Aspergillus fumigatus is one of the most frequently encountered human pathogen in the genus Aspergillus. The patients with compromised immune status are more prone to develop intracranial infection. Few factors like organ transplants, chemotherapy, intensive care unit admissions, hematological malignancies and long term steroids attribute to the increased morbidity and mortality in patient with intracranial fungal infections. Although, fungal infections are rare in immune competent patients, there are few exceptions. Here we present a case of 43-year-old male patient presented with complains of difficulty in walking, headache, low grade fever, dizziness and loss of hearing on left side since one year with past history of frequent ear infection and pus discharge for which he had undergone modified radical mastoidectomy. The patient din not had any significant past history or any other co morbid conditions. The routine blood investigations and cerebrospinal fluid examination were almost unremarkable. The blood galactomanon index was positive but beta – D – glucan was negative. The MRI with spectroscopy was suggestive of neoplastic lesion involving left cerebello – pontine angle, left half pons, clivus and petrous. Surgical excision followed by histopathological examination showed acute angled, sepatate and branching hyphae suggestive of aspergillus fungal infection. The presence of fungi was further confirmed by its positivity with periodic acid Schiff stain. The patient was started with voriconazole antifungal therapy and symptomatic therapy. Our case highlights the importance of considering this infrequent entity in routine clinical practice.