Pons Infection Due To Disseminated Aspergillus

Abstract

A 61-year-old patient with a history of hypertension and diabetes mellitus was admitted with newly developed heart failure, acute kidney injury, and nephrotic syndrome. The patient is suspected of being immunocompromised by a hematologic malignancy. Subsequently, developed pulmonary sepsis and neurological deterioration. Neuroimaging revealed diffuse signal abnormalities in the pons with symmetric involvement, but no signs of restricted diffusion. Despite targeted antibiotic therapy, the patient’s condition did not improve, and systemic inflammation persisted. Aspergillus fumigatus was isolated from bronchoalveolar lavage and blood cultures, confirming hematogenous dissemination. Cerebrospinal fluid showed hypoglycorrhachia, hyperproteinorrhachia and a positive galactomannan. Follow-up brain Magnetic Resonance Imaging showed progression of edema and restricted diffusion, indicating disseminated aspergillosis involving the pons. The patient’s condition worsened, leading to multiple organ dysfunction syndrome and death.