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  • Cerebral aspergillosis within new tumour site presents as incidental new brain lesion in patient receiving temozolomide for glioblastoma multiforme

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Findings that shed new light on the possible pathogenesis of a disease or an adverse effect
CASE REPORT
Cerebral aspergillosis within new tumour site presents as incidental new brain lesion in patient receiving temozolomide for glioblastoma multiforme
  1. Shiyuan Anabeth Liu1,
  2. Timothy Sullivan2,
  3. Clare Bryce3,
  4. Amy M Chan4 and
  5. Salvatore Cilmi2
  1. 1 Internal Medicine, Washington University in Saint Louis School of Medicine, Saint Louis, Missouri, USA
  2. 2 Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  3. 3 Pathology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  4. 4 Internal Medicine, Neurology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
  1. Correspondence to Dr Shiyuan Anabeth Liu, shiyuanliu610{at}gmail.com, saliu{at}wustl.edu

Abstract

Glioblastoma multiforme (GBM) is an aggressive tumour that can lead to lymphopaenia. Its standard treatment involves temozolomide (TMZ) chemotherapy with radiation, often with addition of corticosteroids for symptomatic management. Although TMZ is also immunosuppressive, patients receiving TMZ rarely develop disseminated opportunistic infections. Here, we report the case of a patient with GBM receiving TMZ, radiotherapy and corticosteroids, who develops an incidental new brain lesion that is found to be disseminated Aspergillus within a new GBM tumour site. The patient received successful early treatment of her central nervous system aspergillosis. This case illustrates the profound immunosuppressive potential of GBM in conjunction with TMZ and corticosteroids, which can lead to high-morbidity opportunistic infections concurrently with tumour progression. Future research is needed to elucidate GBM, TMZ and corticosteroids’ compound immune effects and guide management that strikes a balance between treating high-morbidity infections and continuing with immunosuppressive chemotherapy.

  • malignant disease and immunosuppression
  • neuro-oncology
  • chemotherapy
  • infectious diseases

https://doi.org/10.1136/bcr-2018-227500

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    Footnotes

    • Contributors All authors conceived and designed the project. SAL wrote the first draft of the article. TS and SC critically reviewed the manuscript from infectious disease perspective. CB provided key revisions from the perspective of neuropathology. AMC provided revisions from neuro-oncology perspective and obtained patient’s consent for publication. TS and AMC provided clinical updates to be included in the manuscript. SAL critically reviewed the manuscript and wrote subsequent drafts. AMC and CB provided multimedia content. All authors read the final draft and gave approval of the current version to be published.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Patient consent for publication Obtained.