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CC BY-NC-ND 4.0 · Asian J Neurosurg 2023; 18(02): 336-341
DOI: 10.1055/s-0043-1768570
Case Report

A Rare Case of COVID-19-Associated Solitary Aspergillus Brain Abscess

Rajeev Mandaka Parambil 
1   Department of Neurosurgery, Government Medical College, Kozhikode, Kerala, India
,
Binoy Damodar Thavara
1   Department of Neurosurgery, Government Medical College, Kozhikode, Kerala, India
,
Saji Francis
2   Department of Pathology, Government Medical College, Kozhikode, Kerala, India
,
Poornima Mankara Valsan
3   Department of Microbiology, Baby Memorial Hospital, Kozhikode, Kerala, India
,
Byjo Valiyaveetil Jose 
1   Department of Neurosurgery, Government Medical College, Kozhikode, Kerala, India
,
Vishal Mangla
1   Department of Neurosurgery, Government Medical College, Kozhikode, Kerala, India
,
Harikrishnan Sreenivasan
1   Department of Neurosurgery, Government Medical College, Kozhikode, Kerala, India
,
Shanavas Cholakkal 
1   Department of Neurosurgery, Government Medical College, Kozhikode, Kerala, India
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Abstract

Surgically operated case of solitary Aspergillus brain abscess caused by Aspergillus fumigatus in coronavirus disease 2019 (COVID-19) patient is not reported. The authors report a case of 33-year-old diabetic female patient presented with generalized seizure followed by left hemiparesis. Patient was treated with steroids for COVID-19 pneumonia. Initial imaging revealed a right frontal lobe infarct that later confirmed as a case of frontal lobe abscess. Patient underwent craniotomy and thick yellow pus was drained. Abscess wall was excised. Postoperatively patient improved with Glasgow coma scale 15/15 and Medical Research Committee grade 5 power of all limbs. Microbiological examination of pus was done. The gram stain showed numerous pus cells with acute angle branching hyphae. Gomori methenamine silver (GMS) preparation showed filamentous black colored hyphae. Mycelial colonies appeared on chocolate agar after 48 hours of incubation. Cellophane tape mount from the plate showed conical shaped vesicle with conidia arising from the upper third of vesicle. Light green velvety colonies appeared on Sabouraud Dextrose Agar that later turned into smoky green. The isolate was identified as Aspergillus fumigatus. The hematoxylin and eosin stain of abscess wall section showed extensive areas of necrosis with few fungal hyphae. GMS stain of abscess wall showed fungal hyphae that are septate and showing acute angled branching which are consistent with Aspergillus species. Patient was treated with voriconazole. Imaging done after 8 months of surgery revealed no residue. Surgical excision of life-threatening solitary Aspergillus brain abscess along with antifungal medication voriconazole carries good result. The authors believe that decreased immunity in patient has contributed to the development of this rare disease. This is a rarest case of surgically operated solitary brain abscess caused by Aspergillus fumigatus in COVID-19 patient.

Keywords

Aspergillus fumigatus - brain abscess - COVID-19 - diabetes - fungal infection

Informed Consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the patient has given her consent for her images and other clinical information to be reported in the journal. The patient understands that her name and initial will not be published and due efforts will be made to conceal her identity, but anonymity cannot be guaranteed.




Publication History

Article published online:
06 June 2023

© 2023. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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