Disseminated Multi-Organ Aspergillosis with Acute Cerebral Infarction in A Patient with Myelodysplastic Syndrome: A Case Report

Abstract

Background: Central nervous system invasive aspergillosis (CNS-IA) is a relatively uncommon but frequently fatal infectious disease, especially in immunodeficiency patients. The clinical manifestations of CNS-IA are diverse; however, the cases with blindness and cerebrovascular events as the main clinical manifestations are extremely rare. We present, herein, the case of a patient with myelodysplastic syndrome, who was diagnosed with disseminated aspergillosis involving the CNS, lungs, and eyeballs, followed by a fatal basal ganglia infarction as the major cause of death. This report reveals the diversity of clinical manifestations in the patients with CNS-IA, and essence of a dreadful infectious disease.

Case presentation: A 48-year-old male patient with myelodysplastic syndrome was admitted to the hospital with progressive visual extinction in the left eye and recurrent fever. Imaging examination showed multiple intracranial and pulmonary lesions. The metagenomic next-generation sequencing (mNGS) test of the patient’s peripheral blood and cerebrospinal fluid both positive for Aspergillus nidulans. Endophthalmitis was diagnosed based on the patient’s clinical symptoms and mass-like echogenicity observed in the atrium on ophthalmologic ultrasound. Combined antifungal therapy (voriconazole + caspofungin) was provided to the patient, followed by significant symptom relief and imaging improvement at the time of one week post treatment. However, after the continued antifungal treatment for another four days, the patient suddenly suffered from new-onset acute infarcts in the left basal ganglia, and died five days later.

Conclusions: CNS-IA is an infectious disease with diverse clinical manifestations and high mortality. Due to the angioinvasive capacity of Aspergillus, multiple organ involvement, especially more severe cerebrovascular events may occur in patients with CNS-IA, which is worth clinicians to be alert to this complication.