A Patient with Repeated Hemorrhage during Coil Embolization of Aspergillus Aneurysm Rupture

Abstract

Objective: There are few reports of fungal aneurysms developing in the basilar artery where endovascular therapy has been provided. Cerebral infarction was observed before the occurrence of the aneurysm. The aneurysm ruptured repeatedly during treatment. Since the clinical course was complicated, it is reviewed in the literature. Case Presentation: A 71-year-old female patient receiving chemotherapy was admitted with a chief complaint of fever. On the day of hospitalization, right-sided paralysis appeared. MRI confirmed a pontine infarction. A sudden decrease in the consciousness level was observed on the 7th day of hospitalization. Head CT showed subarachnoid hemorrhage. The formation of a basilar artery aneurysm was confirmed on 3D-CTA. We suspected an infectious aneurysm and treated using coil embolization. This aneurysm ruptured repeatedly during treatment. The patient died on the 28th day of hospitalization. From the cerebrospinal fluid examination and autopsy results, subarachnoid hemorrhage due to ruptured infectious aneurysm caused by Aspergillus was diagnosed. Conclusion: An endosaccular embolization of an Aspergillus aneurysm caused repeated intraoperative rupture and the prognosis was poor.