Central nervous system aspergillosis

Background Central nervous system aspergillosis is clinically rare. We present one case of central nervous system aspergillosis diagnosed by pathology, analyze its clinical features, review the literature，and summarize key diagnostic and therapeutic points. Methods and Results The patient, a 50- year-old woman, presented clinically with progressive weakness in limbs, epileptic seizures, and cognitive decline. Systemic inflammation - immune markers and cerebrospinal fluid (CSF) analysis showed no significant abnormalities. Head MRI revealed abnormal signals in both frontal and parietal lobes with patchy and ring-enhancing lesions and meningeal enhancement. Neuropathology suggested vasculitis and brain tissue necrosis with hemorrhage. Periodic acid methenamine staining revealed fungal hyphae with apparent septation and branching at 45° angles. The final diagnosis was central nervous system aspergillosis. Following antifungal and other symptomatic treatments, the patient's symptoms improved, and follow-up brain MRI showed reduction in lesion size. Conclusions Patients with central nervous system aspergillosis may not have a clear underlying immunodeficiency, and clinical manifestations are lack of specificity. CSF may show no inflammatory changes, and metagenomic next-generation sequencing (mNGS) may be negative. Brain biopsy is the primary diagnostic method. Early, adequate and full-course antifungal treatment with voriconazole can improve the prognosis.