Disseminated Aspergillosis in a Patient With Neurosarcoidosis: Persistent Contrast Enhancement in CNS Despite Prolonged Antifungal Treatment: A Case Report

Lakshman Arcot Jayagopal; Afsaneh Shirani; Kelly Cawcutt; Jie Chen; Ana Yuil-Valdes; Rana Zabad

doi:10.1177/11795735231195756

Disseminated Aspergillosis in a Patient With Neurosarcoidosis: Persistent Contrast Enhancement in CNS Despite Prolonged Antifungal Treatment: A Case Report

Lakshman Arcot Jayagopal, Afsaneh Shirani, Kelly Cawcutt, Jie Chen, Ana Yuil-Valdes, Rana Zabad

Research output: Contribution to journal › Article › peer-review

Abstract

A 56-year-old Caucasian man was diagnosed with definite neurosarcoidosis after he presented with progressive bilateral lower extremity weakness and dysesthesia. He was started on a combination immunosuppressant regimen of dexamethasone, methotrexate and infliximab. Two months into treatment with immunosuppressants, he developed devastating disseminated aspergillosis which clinically stabilized with aggressive antifungal treatment however had a protracted radiological course despite prolonged anti-fungal treatment for over two years. Interestingly, he remained in remission from neurosarcoidosis off immunosuppression during the same period. This case emphasizes need for vigilance for fungal infections in patients treated with combination immunosuppressive therapy particularly TNF-α inhibitors such as infliximab.

Original language	English (US)
Journal	Journal of Central Nervous System Disease
Volume	15
DOIs	https://doi.org/10.1177/11795735231195756
State	Published - Jan 1 2023

Keywords

case report
central nervous system aspergillosis
neurosarcoidosis
tumor necrosis factor-α inhibitors
voriconazole

ASJC Scopus subject areas

Clinical Neurology
Neurology
Cellular and Molecular Neuroscience

Access to Document

10.1177/11795735231195756

Cite this

@article{6b6cf5e882294a13a05822513ea142dd,

title = "Disseminated Aspergillosis in a Patient With Neurosarcoidosis: Persistent Contrast Enhancement in CNS Despite Prolonged Antifungal Treatment: A Case Report",

abstract = "A 56-year-old Caucasian man was diagnosed with definite neurosarcoidosis after he presented with progressive bilateral lower extremity weakness and dysesthesia. He was started on a combination immunosuppressant regimen of dexamethasone, methotrexate and infliximab. Two months into treatment with immunosuppressants, he developed devastating disseminated aspergillosis which clinically stabilized with aggressive antifungal treatment however had a protracted radiological course despite prolonged anti-fungal treatment for over two years. Interestingly, he remained in remission from neurosarcoidosis off immunosuppression during the same period. This case emphasizes need for vigilance for fungal infections in patients treated with combination immunosuppressive therapy particularly TNF-α inhibitors such as infliximab.",

keywords = "case report, central nervous system aspergillosis, neurosarcoidosis, tumor necrosis factor-α inhibitors, voriconazole",

author = "{Arcot Jayagopal}, Lakshman and Afsaneh Shirani and Kelly Cawcutt and Jie Chen and Ana Yuil-Valdes and Rana Zabad",

note = "Publisher Copyright: {\textcopyright} The Author(s) 2023.",

year = "2023",

month = jan,

day = "1",

doi = "10.1177/11795735231195756",

language = "English (US)",

volume = "15",

journal = "Journal of Central Nervous System Disease",

issn = "1179-5735",

publisher = "SAGE Publications Inc.",

}

TY - JOUR

T1 - Disseminated Aspergillosis in a Patient With Neurosarcoidosis

T2 - Persistent Contrast Enhancement in CNS Despite Prolonged Antifungal Treatment: A Case Report

AU - Arcot Jayagopal, Lakshman

AU - Shirani, Afsaneh

AU - Cawcutt, Kelly

AU - Chen, Jie

AU - Yuil-Valdes, Ana

AU - Zabad, Rana

N1 - Publisher Copyright: © The Author(s) 2023.

PY - 2023/1/1

Y1 - 2023/1/1

N2 - A 56-year-old Caucasian man was diagnosed with definite neurosarcoidosis after he presented with progressive bilateral lower extremity weakness and dysesthesia. He was started on a combination immunosuppressant regimen of dexamethasone, methotrexate and infliximab. Two months into treatment with immunosuppressants, he developed devastating disseminated aspergillosis which clinically stabilized with aggressive antifungal treatment however had a protracted radiological course despite prolonged anti-fungal treatment for over two years. Interestingly, he remained in remission from neurosarcoidosis off immunosuppression during the same period. This case emphasizes need for vigilance for fungal infections in patients treated with combination immunosuppressive therapy particularly TNF-α inhibitors such as infliximab.

AB - A 56-year-old Caucasian man was diagnosed with definite neurosarcoidosis after he presented with progressive bilateral lower extremity weakness and dysesthesia. He was started on a combination immunosuppressant regimen of dexamethasone, methotrexate and infliximab. Two months into treatment with immunosuppressants, he developed devastating disseminated aspergillosis which clinically stabilized with aggressive antifungal treatment however had a protracted radiological course despite prolonged anti-fungal treatment for over two years. Interestingly, he remained in remission from neurosarcoidosis off immunosuppression during the same period. This case emphasizes need for vigilance for fungal infections in patients treated with combination immunosuppressive therapy particularly TNF-α inhibitors such as infliximab.

KW - case report

KW - central nervous system aspergillosis

KW - neurosarcoidosis

KW - tumor necrosis factor-α inhibitors

KW - voriconazole

UR - http://www.scopus.com/inward/record.url?scp=85167931937&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85167931937&partnerID=8YFLogxK

U2 - 10.1177/11795735231195756

DO - 10.1177/11795735231195756

M3 - Article

C2 - 37581177

AN - SCOPUS:85167931937

SN - 1179-5735

VL - 15

JO - Journal of Central Nervous System Disease

JF - Journal of Central Nervous System Disease

ER -

Disseminated Aspergillosis in a Patient With Neurosarcoidosis: Persistent Contrast Enhancement in CNS Despite Prolonged Antifungal Treatment: A Case Report

Abstract

Keywords

ASJC Scopus subject areas

Access to Document

Other files and links

Fingerprint

Cite this