02296nas a2200277 4500000000100000008004100001653002200042653001200064653001300076653002700089653002600116100001500142700001300157700001300170700001800183700001300201700001500214700001300229700001700242245008200259856006500341300000800406490000600414520158400420022001402004 2014 d10aMycotic arteritis10aleprosy10aDiabetes10aCerebral aspergillosis10aAspergillus fumigatus1 aSegundo JB1 aSilva MA1 aFilho WE1 aNascimento AC1 aVidal FC1 aBezerra GF1 aViana GM1 aNascimento M00aCerebral aspergillosis in a patient with leprosy and diabetes: a case report. uhttp://www.biomedcentral.com/content/pdf/1756-0500-7-689.pdf a6890 v73 a
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, Piaui. He presented with headache, seizures, confusion, fever and left hemiparesis upon hospitalization in 2006 at Hospital Sao 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/mm3 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.
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