Invasive aspergillosis in an immunocompetent patient: A retrospective case report and review of the literature.

Abstract

Introduction: Invasive aspergillosis (IA) is rare in immunocompetent patients. We present the case of a 44-year-old female with IA invading the lungs, mediastinum, heart, and brain, with a disease duration of 11 years.

Case presentation: The patient was initially diagnosed with lung aspergillosis that had invaded the mediastinum on October 8, 2008. Irregular uptake of itraconazole led to the aggravation of lung lesions. Echocardiography and enhanced magnetic resonance imaging revealed a large irregular mass in the left atrium and an enhanced 1-cm nodular lesion in the right frontal lobe respectively in 2016. The patient refused to undergo a biopsy of the cardiac mass. Oral itraconazole (200 mg, twice daily) was recommended for subsequent days. The intracranial lesion gradually enlarged, and a complete tumor resection of the right frontal lobe was performed on February 23, 2017. The patient`s condition was well controlled with oral voriconazole by the end of follow-up until April 11, 2019. We conducted a search across multiple databases, including PubMed, Web of Science, Scopus, and Science Direct. We aimed to identify cases of aspergillosis that simultaneously invaded the lungs, heart, and brain. The details of these cases are summarized.

Results: Fourteen cases with available data met the requirements, and the mortality rate of these 14 cases was 100%.

Conclusions: IA can occur even in immunocompetent patients receiving antifungal therapy. Therefore, timely diagnosis and effective long-term antifungal treatments are crucial. Voriconazole is an effective antifungal drug that is used to treat cerebral aspergillosis.