Mencinger Maruša, Matos Tadeja, Popović Katarina Šurlan
Clinical Institute of Radiology, University Medical Centre Ljubljana, Zaloška 7, 1000 Ljubljana, Slovenia.
Institute of Microbiology and Immunology, Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
Radiol Case Rep. 2021 Jul 16;16(9):2651-2657. doi: 10.1016/j.radcr.2021.06.041. eCollection 2021 Sep.
Invasive sinus aspergillosis is a rare life-threatening condition usually found in immunocompromised patients. The fungus spreads from paranasal sinuses into the central nervous system by direct extension or through blood vessels. Perineural spread is an uncommon mechanism of spread in invasive aspergillosis. A mycotic aneurysm is a dangerous complication of invasive sinus aspergillosis because of its insidious development and is often diagnosed only post-mortem after causing fatal intracranial hemorrhage. Intracranial vascular complications of invasive sinus aspergillosis require prompt recognition and treatment and should always be considered when a diagnosis of CNS aspergillosis is made. We present a case of invasive sinus aspergillosis in an apparently immunocompetent patient that manifested with a brain abscess, perineural spread of the infection, and mycotic aneurysm of the vertebral artery with subsequent rupture and fatal subarachnoid hemorrhage. This case highlights the possibility of perineural spread and hemorrhagic complications in invasive cerebral aspergillosis.
侵袭性鼻窦曲霉菌病是一种罕见的危及生命的疾病，通常见于免疫功能低下的患者。真菌通过直接蔓延或经血管从鼻窦扩散至中枢神经系统。神经周围蔓延是侵袭性曲霉菌病一种不常见的扩散机制。霉菌性动脉瘤是侵袭性鼻窦曲霉菌病的一种危险并发症，因其发展隐匿，常仅在导致致命性颅内出血后尸检时才被诊断出来。侵袭性鼻窦曲霉菌病的颅内血管并发症需要及时识别和治疗，在诊断中枢神经系统曲霉菌病时应始终予以考虑。我们报告一例表面免疫功能正常的患者发生侵袭性鼻窦曲霉菌病，表现为脑脓肿、感染的神经周围蔓延以及椎动脉霉菌性动脉瘤，随后破裂并导致致命性蛛网膜下腔出血。该病例突出了侵袭性脑曲霉菌病中神经周围蔓延和出血性并发症的可能性。
