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Intracranial Aspergillosis in an Immunocompetent Young Woman

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Abstract

Intracranial aspergillosis (ICA) is very rare in the immunocompetent individuals, usually misdiagnosed as a tumor or an abscess. A high index of clinical suspicion is required in patients who present with focal neurological deficits, headache, or seizures. We report the case of a 25-year-old immunocompetent female, who presented with a 15-month history of headache, seizures, left-sided proptosis and ophthalmoplegia, and right hemiparesis. Recovery from the symptoms and decrease in the lesion size seen on the radiological assessment were achieved through two decompressive craniotomies followed by prolonged combined systemic antifungal therapies. Although the initial neuroimaging suggested a mitotic pathology, the surgical sample confirmed ICA. Now the patient is on single antifungal therapy (Tab. voriconazole, 200 mg twice daily) and doing her daily activities, but with a reduced intelligent quotient. We report a challenging case of ICA where multiple courses of combined antifungal therapies and repeat surgeries paved the way for a good prognosis.

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Acknowledgements

Special thanks to the team of doctors from the Department of Neurosurgery for operating in the patient twice in succession as required.

Authors’ Contributions

PKP searched the literature, analyzed and drafted the study; SK collected data and drafted the study; NW provided the concept, analyzed, interpreted and revised the work; AG interpreted, including the literature search, especially the radiology data and critically revised the work; MCS and AN searched literature for the pathology part and drafted the work. PKP, SK, and NW were the physicians involved in patient management. All authors read and approved the final manuscript.

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Authors and Affiliations

  1. Department of Internal Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, 110029, India

    Prasan Kumar Panda, Sunil Kumar Mavidi & Naveet Wig

  2. Department of Neuro-Radiology, All India Institute of Medical Sciences, New Delhi, India

    Ajay Garg

  3. Department of Pathology, All India Institute of Medical Sciences, New Delhi, India

    Aasma Nalwa & M. C. Sharma

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  1. Prasan Kumar Panda
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Correspondence to Naveet Wig.

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Panda, P.K., Mavidi, S.K., Wig, N. et al. Intracranial Aspergillosis in an Immunocompetent Young Woman. Mycopathologia 182, 527–538 (2017). https://doi.org/10.1007/s11046-016-0106-4

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