Sunday, December 04, 2011

Recurrent Extra-axial Aspergilloma Mimicking Meningioma

40 year old male comes with history of headache and diplopia of 2 months duration in January 2010. CEMRI Brain was representative of a atypical meningioma with brain edema with only posterior ethmoidal mucosal thickening. At surgery and HPE, it turned out to be extra-axial aspergilloma. After Amphotericin B administration, following surgery, repeat scan 3 months later was near normal. However the present MR suggest gross recurrence. T2 low signals, extensive and disproportionate brain edema, apparent hyperdensity on CT could suggest this possibility.




Teaching points by Dr MGK Murthy, Dr Sumer Sethi, Mr Hari Om :

•Aspergilloma is one of the commonest fungi present in the soil, dust, vegetable matter and timber.

•Infection gets into the body by inhalation of spores into the lungs (preferably damaged tissue), and hematogeneously reaches central nerve system. Alternatively it can reach via nose and para-nasal sinuses.

•Contrary to the popular notion, aspergilloma could occur with no known predisposing immunocompromised factors including diabetes, as in this case. Carpenters by profession are more susceptible for this.

•Prognosis is general poor, though cure is possible with amphotericin B, and less toxic Econazole. Other fungi like Paecilomyces and cephalosporins could mimic aspergilous under the microscope.

4 comments:

Wael Nemattalla said...

I see the mass enhancing; does fungal infection generally enhance?
Though i did not hear about this entity before; it is common in practice. This week i saw two cases and there was discordant edema; we suggested grade II or III meningioma.

Wael Nemattalla said...

I see the mass enhancing; does fungal infection generally enhance?
Though i did not hear about this entity before; it is common in practice. This week i saw two cases and there was discordant edema; we suggested grade II or III meningioma.

Brian Sabb said...

Dear Doctors,

This is a great case! Looks JUST like a meningioma.

Thanks for the teaching points.

Best,

Brian Sabb
www.linkedin.com/in/briansabb

MGK Murthy said...

thanks for the interaction . fungal infections classically produce no cerebral oedema and show concomitant Paranasal sinus involvement apart from immunocompromised host . Well this presentation is unusual and that is what Medicine and this site is all about - showing what surprises us

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