Acute lymphoblastic leukemia with central nervous system <em>Aspergillus</em> infection: A case report and literature review

Yang,Tao; Cai,Yong; Zhu,Yaping

doi:10.3892/etm.2023.12336

Acute lymphoblastic leukemia with central nervous system Aspergillus infection: A case report and literature review

Authors:
- Tao Yang
- Yong Cai
- Yaping Zhu
View Affiliations

Affiliations: Department of Neurosurgery, The First People's Hospital of Huzhou (First Affiliated Hospital of Huzhou University), Huzhou, Zhejiang 313000, P.R. China, Department of Pathology, The First People's Hospital of Huzhou (First Affiliated Hospital of Huzhou University), Huzhou, Zhejiang 313000, P.R. China
Published online on: December 4, 2023 https://doi.org/10.3892/etm.2023.12336
Article Number: 46
Copyright: © Yang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

Ubiquitous in nature, Aspergillus rarely invades the brain to induce infection in general. However, in clinical practice, some patients with hematological malignancies or immunosuppression may suffer from Aspergillus infection of the central nervous system, which arises most commonly as a result of hematogenous dissemination from a pulmonary focus or direct extension from the paranasal sinus infection. Treatment is clinically challenging and the mortality rate is relatively high. Recently, a case diagnosed with acute lymphocytic leukemia was admitted to the Department of Neurosurgery, The First People's Hospital of Huzhou (First Affiliated Hospital of Huzhou University, Huzhou, China). During chemotherapy, space‑occupying lesions were observed in the right occipital lobe of the patient, and lesion progression was captured. After treatment with surgery, an analysis of specimens collected from the patient was performed and was suggestive of Aspergillus infection. Following the symptomatic therapy with voriconazole, the patient's disease prognosis was favorable. The focus of infection due to pulmonary aspergillosis or Aspergillus sinusitis was not detected in the patient and the focus was not a common site of hematogenous infection. In addition, the patient exhibited no obvious clinical symptoms. In view of the above observations, the possibility of hospital‑acquired infection was considered, to which clinicians should be alert.

View Figures

View References

1	Amanati A, Lotfi M, Masoudi MS, Jafarian H, Ghasemi F, Bozorgi H and Badiee P: Cerebral and pulmonary aspergillosis, treatment and diagnostic challenges of mixed breakthrough invasive fungal infections: Case report study. BMC Infect Dis. 20(535)2020.PubMed/NCBI View Article : Google Scholar
2	Furtwängler R, Schlotthauer U, Gärtner B, Graf N and Simon A: Nosocomial legionellosis and invasive aspergillosis in a child with T-lymphoblastic leukemia. Int J Hyg Environ Health. 220:900–905. 2017.PubMed/NCBI View Article : Google Scholar
3	Xue Q, Lei Y, Zhan C, Liao WQ and Hou LJ: Retrospective analysis of cerebral aspergillosis in mainland China from 2000 to 2019. Chin J Mycol. 14:134–140. 2019.
4	Turgut M, Ozsunar Y, Oncü S, Akyüz O, Ertuğrul MB, Tekin C, Gültekin B and Sakarya S: Invasive fungal granuloma of the brain caused by Aspergillus fumigatus: A case report and review of the literature. Surg Neurol. 69:169–174. 2008.PubMed/NCBI View Article : Google Scholar
5	Kumar D, Nepal P, Singh S, Ramanathan S, Khanna M, Sheoran R, Bansal SK and Patil S: CNS aspergilloma mimicking tumors: Review of CNS Aspergillus infection imaging characteristics in the immunocompetent population. J Neuroradiol. 45:169–176. 2018.PubMed/NCBI View Article : Google Scholar
6	Chiu CY and Miller SA: Clinical metagenomics. Nat Rev Gen. 20:341–355. 2019.PubMed/NCBI View Article : Google Scholar
7	Chen S, Zhou Y, Chen Y and Gu J: fastp: An ultra-fast all-in-one FASTQ preprocessor. Bioinformatics. 34:i884–i890. 2018.PubMed/NCBI View Article : Google Scholar
8	Langmead B and Salzberg S: Fast gapped-read alignment with bowtie 2. Nat Methods. 9:357–359. 2012.PubMed/NCBI View Article : Google Scholar
9	Cherian T, Giakoustidis A, Yokoyama S, Heneghan M, O'Grady J, Rela M, Wendon J, Heaton DN and Verma A: Treatment of refractory cerebral aspergillosis in a liver transplant recipient with voriconazole: Case report and review of the literature. Exp Clin Transplant. 10:482–486. 2012.PubMed/NCBI View Article : Google Scholar
10	Zhu HM, Jia YP, Chen M, Zhao J and Wen H: Antifungal therapy in severe rhinosino-optical-otic and cerebral invasive aspergillosis caused by Aspergillus flavus. Chin J Mycol. 4:90–92. 2009.
11	Ganesh P, Nagarjuna M, Shetty S, Kumar P, Bhat V and Salins PC: Invasive aspergillosis presenting as swelling of the buccal mucosa in an immunocompetent individual. Oral Surg Oral Med Oral Pathol Oral Radiol. 119:e60–e64. 2015.PubMed/NCBI View Article : Google Scholar
12	Hersh CM, John S, Subei A, Willis MA, Kosmorsky GS, Prayson RA and Bhimraj A: Optic neuropathy and stroke secondary to invasive Aspergillus in an immunocompetent patient. J Neuroophthalmol. 36:404–407. 2016.PubMed/NCBI View Article : Google Scholar
13	Schwartz S and Thiel E: Cerebral aspergillosis: Tissue penetration is the key. Med Mycol. 47 (Suppl 1):S387–S393. 2009.PubMed/NCBI View Article : Google Scholar
14	Nyga R, Delette C, Mabille C, Bennis Y, Chouaki T, Boone M, Maizel J, Marolleau JP and Joseph C: Ibrutinib related cerebral aspergillosis successfully treated with isavuconazole: A case report. Leuk Lymphoma. 61:1760–1762. 2020.PubMed/NCBI View Article : Google Scholar
15	Li YF and Li HJ: A case of AIDS associated Aspergillus infection in brain. Radiol Pract. 27:1038–1039. 2012.
16	Nadkarni T and Goel A: Aspergilloma of the brain: An overview. J Postgrad Med. 51 (Suppl 1):S37–S41. 2005.PubMed/NCBI
17	Koh S, Ross LA, Gilles FH, Nelson MD Jr and Mitchell WG: Myelopathy resulting from invasive aspergillosis. Pediatr Neurol. 19:135–138. 1998.PubMed/NCBI View Article : Google Scholar
18	Christophe C, Azzi N, Bouché B, Dan B, Levivier M and Ferster A: Magnetic resonance imaging and angiography in cerebral fungal vasculitis. Neuropediatrics. 30:218–220. 1999.PubMed/NCBI View Article : Google Scholar
19	Chong GM, Maertens JA, Lagrou K, Driessen GJ, Cornelissen JJ and Rijnders BJ: Diagnostic performance of galactomannan antigen testing in cerebrospinal fluid. J Clin Microbiol. 54:428–431. 2016.PubMed/NCBI View Article : Google Scholar
20	De Vlieger G, Lagrou K, Maertens J, Verbeken E, Meersseman W and Van Wijngaerden E: Beta-D-glucan detection as a diagnostic test for invasive aspergillosis in immunocompromised critically ill patients with symptoms of respiratory infection: An autopsy-based study. J Clin Microbiol. 49:3783–3787. 2011.PubMed/NCBI View Article : Google Scholar
21	Xing XW, Zhang JT, Ma YB, He MW, Yao GE, Wang W, Qi XK, Chen XY, Wu L, Wang XL, et al: Metagenomic next-generation sequencing for diagnosis of infectious encephalitis and meningitis: A large, prospective case series of 213 patients. Front Cell Infect Microbiol. 10(88)2020.PubMed/NCBI View Article : Google Scholar
22	Xing XW, Yu SF, Zhang JT, Tan RS, Ma YB, Tian X, Wang RF, Yao GE, Cui F, Gui QP and Yu SY: Metagenomic next-generation sequencing of cerebrospinal fluid for the diagnosis of cerebral aspergillosis. Front Microbiol. 12(787863)2021.PubMed/NCBI View Article : Google Scholar
23	Le TH, Kumar V, Gondal K, Barnes M, Siddique H, Buttar B and Kaell A: Isolated central nervous system aspergillosis infection in a chronic lymphocytic leukemia patient on Ibrutinib: A case report. BMC Infect Dis. 20(175)2020.PubMed/NCBI View Article : Google Scholar
24	McCarter SJ, Vijayvargiya P, Sidana S, Nault AM, Lane CE, Lehman JS, Wilson JW, Parikh SA, Nowakowski GS and Al-Kali A: A case of ibrutinib-associated aspergillosis presenting with central nervous system, myocardial, pulmonary, intramuscular, and subcutaneous abscesses. Leuk Lymphoma. 60:559–561. 2019.PubMed/NCBI View Article : Google Scholar
25	Eichenberger EM, Saullo J, Brander D, Wang SH, Perfect JR and Messina JA: A case of CNS aspergillosis in a patient with chronic lymphocytic leukemia on first-line ibrutinib therapy. Med Mycol Case Rep. 27:17–21. 2019.PubMed/NCBI View Article : Google Scholar
26	Peddada K, Khan NM, Rubin J, Zakaryan H, Liu Y, Popnikolov N, Sangani R and Li W: Diagnosis of vitreoretinal aspergillosis with transvitreal retinochoroidal biopsy. Case Rep Ophthalmol Med. 2018(8306163)2018.PubMed/NCBI View Article : Google Scholar
27	McCaslin AF, Lall RR, Wong AP, Lall RR, Sugrue PA and Koski TR: Thoracic spinal cord intramedullary Aspergillus invasion and abscess. J Clin Neurosci. 22:404–406. 2015.PubMed/NCBI View Article : Google Scholar
28	Lin C, Barrio GA, Hurwitz LM and Kranz PG: Cerebral air embolism from angioinvasive cavitary aspergillosis. Case Rep Neurol Med. 2014(406106)2014.PubMed/NCBI View Article : Google Scholar
29	Davoudi S, Anderlini P, Fuller GN and Kontoyiannis DP: A long-term survivor of disseminated Aspergillus and mucorales infection: An instructive case. Mycopathologia. 178:465–470. 2014.PubMed/NCBI View Article : Google Scholar
30	Beresford R, Dolot V and Foo H: Cranial aspergillosis in a patient receiving ibrutinib for chronic lymphocytic leukemia. Med Mycol Case Rep. 24:27–29. 2019.PubMed/NCBI View Article : Google Scholar
31	Peng HL, Yi YF, Shen XH, Yin YF and Zhang GS: Dramatic response to itraconazole in central nervous system aspergillosis complicating acute promyelocytic leukemia. Infect Dis (Lond). 47:104–106. 2015.PubMed/NCBI View Article : Google Scholar
32	Gaye E, Le Bot A, Talarmin JP, Le Calloch R, Belaz S, Dupont M and Tattevin P: Cerebral aspergillosis: An emerging opportunistic infection in patients receiving ibrutinib for chronic lymphocytic leukemia? Med Mal Infect. 48:294–297. 2018.PubMed/NCBI View Article : Google Scholar
33	Rouzaud C, Jullien V, Herbrecht A, Palmier B, Lapusan S, Morgand M, Guéry R, Dureault A, Danion F, Puget S, et al: Isavuconazole diffusion in infected human brain. Antimicrob Agents Chemother. 63:e02474–18. 2019.PubMed/NCBI View Article : Google Scholar
34	Pouvaret A, Guery R, Montillet M, Molina TJ, Duréault A, Bougnoux ME, Galliot R, Lanternier F, Delarue R and Lortholary O: Concurrent cerebral aspergillosis and abdominal mucormycosis during ibrutinib therapy for chronic lymphocytic leukaemia. Clin Microbiol Infect. 25:771–773. 2019.PubMed/NCBI View Article : Google Scholar
35	Turki AT, Rashidi-Alavijeh J, Dürig J, Gerken G, Rath PM and Witzke O: Successful treatment of cerebral aspergillosis: Case report of a patient with T-cell large granular lymphocytic leukemia (T-LGL). BMC Infect Dis. 17(797)2017.PubMed/NCBI View Article : Google Scholar
36	Matis GK, Voultsinou D, Chrysou O, Birbilis T and Geroukis T: Cerebral aspergillosis and acute myeloid leukemia. J Neurosci Rural Pract. 4 (Suppl 1):S134–S135. 2013.PubMed/NCBI View Article : Google Scholar
37	Peri AM, Bisi L, Cappelletti A, Colella E, Verga L, Borella C, Foresti S, Migliorino GM, Gori A and Bandera A: Invasive aspergillosis with pulmonary and central nervous system involvement during ibrutinib therapy for relapsed chronic lymphocytic leukaemia: Case report. Clin Microbiol Infect. 24:785–786. 2018.PubMed/NCBI View Article : Google Scholar
38	De Leonardis F, Novielli C, Giannico B, Mariggiò MA, Castagnola E and Santoro N: Isavuconazole treatment of cerebral and pulmonary aspergillosis in a pediatric patient with acute lymphoblastic leukemia: Case report and review of literature. J Pediatr Hematol Oncol. 42:e469–e471. 2020.PubMed/NCBI View Article : Google Scholar
39	Matsuo T, Mori N, Sakurai A and Furukawa K: Aspergillus meningitis in a patient with chronic lymphocytic leukemia. J Infect Chemother. 26:622–624. 2020.PubMed/NCBI View Article : Google Scholar
40	Sakata N, Okano M, Masako R, Tanaka A, Yamashita Y, Karasuno T, Imadome KI, Okada M and Sugimoto K: Donor-derived myelodysplastic syndrome after allogeneic stem cell transplantation in a family with germline GATA2 mutation. Int J Hematol. 113:290–296. 2021.PubMed/NCBI View Article : Google Scholar
41	Kural C, Ozer MI, Ezgu MC, Mehtiyev R, Yasar S, Kutlay AM, Daneyemez MK, Onguru O, Erdogan E and Izci Y: Intracavitary amphotericin B in the treatment of intracranial aspergillosis. J Clin Neurosci. 51:75–79. 2018.PubMed/NCBI View Article : Google Scholar
42	Sadarangani M, Harvey M, McDonald A, Speert DP and Dix D: Brain abscesses due to Aspergillus nidulans Infection during induction chemotherapy for acute lymphoblastic leukemia. J Pediatr Hematol Oncol. 37:e384–e386. 2015.PubMed/NCBI View Article : Google Scholar