[A case of cerebral aspergilloma following radical operation of a cerebral aneurysm].

A case of aspergillotic abscess with granuloma is reported. A 45-year-old man was admitted to our hospital on Apr. 10, 1984 due to the rupture of an aneurysm of the anterior communicating artery. Neck clipping of the aneurysm was proposed on Apr. 12, 1984, but was not performed because of cardiac arrest with unknown etiology during the operation. Neck clipping was performed on Apr. 23, 1984. Antibiotic therapy was prolonged for about three weeks. About 6 months after surgery, he was readmitted on Oct. 12, 1984 with the chief complaint of general fatigue and headache. On readmission, laboratory examinations were normal except for leukocytosis, elevated ESR and positive CRP. Neurological examination revealed left papilledema, disorientation and memory disturbance. On lumbar puncture, the cerebrospinal fluid showed 2 lymphocytes, 71 mg percent protein, 94 mg percent glucose. The skull and chest X-ray findings were normal. The CT scan revealed an irregular low density area in the left frontal lobe with abnormal enhancement. Steroids and antibiotic therapy were initiated. Since mass signs on CT scan increased gradually, partial removal of abscess and granuloma was performed on Nov. 5, 1984. From the necrotic granuloma, Aspergillus was microscopically recognized and Aspergillus fumigatus was cultured on Sabouraud's medium. Immunologically, serum immunoglobulin levels and the subset of lymphocytes were normal. Tuberculin reaction was negative. After the operation, amphotericin-B and 5-fluorocytosine (5-FC) were administered. Nevertheless mass signs on CT scan increased again. The fourth operation was performed on Dec. 6, 1984.(ABSTRACT TRUNCATED AT 250 WORDS)