Cerebral aspergillosis in immunocompromised patient successfully treated with voriconazole

Cerebral aspergillosis is a severe invasive mycosis occurring in immunocompromised patients. This pathology is associated with a high rate of mortality and is a current complication of pulmonary invasive aspergillosis. We report the case of a 44-year-old immunocompromised male with a recent history of oropharyngeal carcinoma. At his admission the patient presented with fever and confusion. Imaging revealed the presence of a cerebral abscess combined with lung infiltrates. During hospitalization and despite a broad-spectrum antibiotic regimen his condition worsened. A thin needle aspiration of the abscess was performed for diagnosis purpose. Histological examination of the tissue showed septate and branched hyphae with 45° angles suggestive of Aspergillus. A real-time PCR specific for the detection of Aspergillus sp. was carried out and confirmed the fungal etiology of the abscess. Rare colonies of A. fumigatus were isolated a few days later. The diagnosis of invasive pulmonary aspergillosis complicated by a cerebral dissemination was confirmed. Antifungal treatment based on voriconazole 4 mg/kg q12h was introduced and the dosage was successfully increased up to 5 mg/kg q12h by drug monitoring. This case highlights the usefulness of the Aspergillus PCR for the rapid identification of hyphae in tissue biopsies (or in the event of negative culture), and the importance of therapeutic drug monitoring in treatment by voriconazole.