SHM Converge Scientific Abstract ePoster Gallery-Not a Bluff: An Atypical Case of CNS Aspergillus Abscess Masquerading as a Malignancy

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An 83-year-old man with chronic lymphocytic leukemia (CLL) treated with ibrutinib presented with one week of weakness, dizziness, blurred vision, confusion, and word-finding difficulty. Examination showed dysmetria and right-sided peripheral vision loss. Head CT revealed a 3.7 cm left parieto-occipital mass with edema and midline shift, initially concerning for lymphoma or another malignancy. His symptoms improved with IV steroids, and ibrutinib was held. However, brain MRI suggested an intracranial abscess rather than metastasis.<br /><br />Neurosurgical biopsy and partial evacuation were performed. Pathology and culture identified Aspergillus fumigatus, confirming CNS aspergillosis. Blood flow cytometry showed no Richter transformation. He was started on lifelong voriconazole, and follow-up MRI at 3.5 months showed the abscess had decreased from 3 cm to 1.5 cm.<br /><br />This case highlights the need to consider invasive aspergillosis in immunocompromised patients on ibrutinib who develop new neurologic symptoms, even without fever or other systemic signs of infection. CNS aspergillosis is a highly morbid infection with substantial fatality risk, and early recognition is crucial. The report emphasizes that presentation may be atypical, including isolated CNS disease and delayed onset during ibrutinib therapy.

Asset Subtitle

Hannah E. Gill

Meta Tag

Author List Geneva E. Guarin, Hannah E. Gill, Randy O. Laine

Category Clinical Vignettes

Concept Central Nervous System Infection

Concept Disseminated Invasive Aspergillosis

Concept Cerebral Aspergillosis

Concept Focal Neurologic Deficit

Concept Ibrutinib

Distinguished Non-Finalist

Presenter Organization Washington University School of Medicine

Presenting Author Hannah E. Gill

Track Adult

Keywords

chronic lymphocytic leukemia

ibrutinib

CNS aspergillosis

Aspergillus fumigatus

intracranial abscess

immunocompromised

neurologic symptoms

voriconazole

brain MRI

neurosurgical biopsy

Central Nervous System Infection

Disseminated Invasive Aspergillosis

Cerebral Aspergillosis

Focal Neurologic Deficit

Ibrutinib