Abstract

Background. Invasive cerebral aspergillosis is an uncommon and potentially fatal condition usually occurs in immunocompromised patients but may develop in immunocompetent individuals, particularly after undergoing sinus surgery.
Case presentation: A 45-year-old man with no past medical history other than sinus surgery presented to the E.R. with fever, generalized seizures, and altered mental status. After the initial workup, he was diagnosed with malaria, which was incorrect and deteriorated with treatment. Brain imaging revealed a frontal mass with sinus involvement and midline shift. So, he had a craniectomy with the excision of necrotic brain tissue. Histologic examination showed necrotizing Aspergillus angiitis from Aspergillus fumigatus. He had a good response to voriconazole therapy.
Conclusion: This case emphasizes the need to rule out fungal infections of the central nervous system in patients with a history of uncomplicated sinus surgery and unexplainable neurologic signs and symptoms.

Key words: Aspergillus, cerebral aspergillosis, fungal brain infection, sinus surgery, voriconazole.