Kankam Samuel Berchi, Saffar Hiva, Shafizadeh Milad, Afhami Shirin, Khoshnevisan Alireza
Department of Neurosurgery, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
International Neurosurgery Group (ING), Universal Scientific Education and Research Network (USERN), Tehran, Iran.
Ann Med Surg (Lond). 2022 Aug;80:104122. doi: 10.1016/j.amsu.2022.104122. Epub 2022 Jul 7.
Although some immunocompetent patients have developed invasive aspergillosis, the vast majority of cases are seen in immunocompromised patients. COVID-19 infection has been proposed to cause immune dysfunction or suppression, which predisposes patients to fungal co-infections such as mucormycosis and aspergillosis.
A 58-year-old woman was admitted to the hospital with confusion, dysarthria, and loss of consciousness. The patient had a 1-month prior history of severe COVID-19 infection. A computerized tomography (CT) scan and a magnetic resonance imaging (MRI) revealed an intraventricular lesion with perilesional edema and a significant midline shift, which was initially thought to be an intraventricular tumor. Following a posterior parietal craniotomy, the lesion was resected via a transcortical approach from the posterior parietal region to the right lateral ventricle. Histopathological findings confirmed intraventricular aspergillosis (IVA). The patient was treated with intravenous amphotericin B for two months and discharged with oral variconazole for 4 months.
Covid-19 infections can result in- dissemination of fungal diseases such as aspergillosis. As a minor component of cerebral aspergillosis with a poor prognosis, intraventricular aspergillosis necessitates prompt treatment, which includes surgical resection and the administration of anti-fungal medications.
Infection with COVID-19 causes immune dysfunction, which leads to fungal co-infection, including CNS aspergillosis. As a result, all COVID-19 patients who present with acute neurologic symptoms should have CNS aspergillosis considered in their differential diagnosis.
尽管一些免疫功能正常的患者也发生了侵袭性曲霉病，但绝大多数病例见于免疫功能低下的患者。有人提出，新型冠状病毒肺炎（COVID-19）感染可导致免疫功能障碍或抑制，使患者易发生真菌合并感染，如毛霉病和曲霉病。
一名58岁女性因意识模糊、构音障碍和意识丧失入院。该患者有1个月前严重COVID-19感染病史。计算机断层扫描（CT）和磁共振成像（MRI）显示脑室内病变伴病变周围水肿和明显的中线移位，最初认为是脑室内肿瘤。在后顶叶开颅术后，通过经皮质入路从后顶叶区域至右侧脑室切除病变。组织病理学检查结果证实为脑室内曲霉病（IVA）。患者接受了两个月的静脉注射两性霉素B治疗，出院时口服伏立康唑4个月。
COVID-19感染可导致曲霉病等真菌疾病的播散。作为脑曲霉病的一个预后较差的次要组成部分，脑室内曲霉病需要及时治疗，包括手术切除和抗真菌药物治疗。
COVID-19感染导致免疫功能障碍，进而导致真菌合并感染，包括中枢神经系统曲霉病。因此，所有出现急性神经症状的COVID-19患者在鉴别诊断时都应考虑中枢神经系统曲霉病。
