Pulmonary Aspergillosis with Possible Cerebral Involvement in a Previously Healthy Pregnant Woman

• Published in: Journal of chemotherapy (Florence) Vol. 16; no. 6; pp. 604 - 617
• Main Authors: Pagliano, P., Attanasio, V., Fusco, U., Rossi, M., Scarano, F., Faella, F.S.
• Format: Journal Article
• Language: English
• Published: England Taylor & Francis 01-12-2004
• Subjects: Adult; Antifungal Agents - therapeutic use; Aspergillosis; Aspergillosis, Allergic Bronchopulmonary - complications; Aspergillus; Aspergillus fumigatus - isolation & purification; Aspergillus fumigatus - pathogenicity; Brain Abscess - drug therapy; Brain Abscess - microbiology; cerebral abscess; Cesarean Section; Female; Humans; meningitis; Neuroaspergillosis - complications; Neuroaspergillosis - drug therapy; Neuroaspergillosis - etiology; Pregnancy; Pregnancy Complications, Infectious - microbiology; Pregnancy Complications, Infectious - pathology; Seizures - etiology; Seizures - microbiology; Treatment Outcome
• ISSN: 1120-009X; 1973-9478
• DOI: 10.1179/joc.2004.16.6.604

Invasive aspergillosis is observed mainly in immunodepressed patients. Here we report a case of pulmonary aspergillosis with CNS involvement in a pregnant woman without other known causes of immunodeficiency.
Case report: A 23-years old pregnant woman underwent a caesarean because of unexplained seizures. During the subsequent days worsening headache and a dete-riorating neurological status were reported suggesting meningitis. Stiffness, right sided hemiparesis and cranial nerve palsies were observed at admission. Radiological findings revealed lesions involving the right pulmonary apex, the right cerebellar hemisphere and the Pterygopalatina fossa. Microbiological studies revealed large colonies of Aspergillus fumigatus. A favorable outcome was observed after administration of liposomal amphotericin B and 5-fluorocytosine and, at improved conditions, when oral uptake of itraconazole was given.
The authors conclude that risk of infections sustained by fungal opportunistic agents during pregnancy must be considered. Sequential antifungal administration may be an efficient therapy able to shorten hospitalization.