Early diagnosis of cerebral aspergillosis with various methods: a case report.

The clinical and laboratory diagnosis of cerebral aspergillosis (CA) is problematic and mortality is quite high, even in cases receiving appropriate treatment. Therefore, an early and accurate diagnosis may prove to be life saving in patients with the diagnosis of CA. In this report, a case of CA which developed in a pediatric patient with acute lymphoblastic leukemia (ALL) is presented. Upon development of neutropenia and focal seizures in the left arm during implementation of the ALL treatment protocol, brain MRI was performed in the patient and nodular lesions compliant with brain abscess were detected in the frontal lobe, left cerebellum and the cingulate gyrus on the superior aspect of the left corpus callosum. Direct assessment of brain tissue revealed fungal elements, while consecutive serum galactomannan (GM) values were determined as 3.39 ng/ml and 0.72 ng/ml, and the consecutive serum (1x3)-beta-D-glucan (BG) values were 93 pg/ml and 356 pg/ml. Negative serum real-time polymerase chain reaction (RtPCR) and positive tissue RtPCR were determined, with growth of Aspergillus fumigatus in the culture. Treatment was initiated with amphotericin B and voriconazole; upon disappearance of symptoms and negative control serum BG and GM values, the patient was discharged with recommendations. In conclusion, this case is presented with the objective of indicating the significance of serological and molecular methods used in the early diagnosis of patients with CA.