A 68-year-old woman with a background of hypertension, stroke and rheumatoid arthritis presented to her local hospital after a 4-week history of gradual deterioration and increasing confusion with new onset right-sided weakness. Her initial CT scan revealed a rim enhancing mass lesion with surrounding oedema in the left parietal lobe for which she underwent CT stealth-guided biopsy. Microbiology culture of the 2 biopsy samples yielded Aspergillus niger and she was started on the antifungal agent voriconazole. MRI 2 weeks after the procedure also demonstrated radiological findings consistent with intracranial aspergillosis. She later developed leucopenia with neutrophils of 1.5×109/L and her methotrexate and voriconazole were stopped. Voriconazole was changed to oral posaconazole. She did not undergo surgical resection and has continued to improve clinically on posaconazole, with recovery in her white cell count.
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Contributors LS, SM, SAC and BW were involved in the conception of the case report. All authors contributed to the collection of data, including case notes, providing email discussions seeking expert opinions, blood and scan results and pathology reports. The first draft was written equally by LS and SM and reviewed by all authors who all contributed detailed revisions, including assistance with interpretation of scan results and the background literature. The final draft has been approved by all authors. All authors have been involved in various aspects of the care of the patient. The fifth author, Dr Denning , contributed at all stages in particular data analysis, interpretation, review of the literature, review and approval of the manuscript.
Competing interests None declared.
Provenance and peer review Not commissioned; externally peer reviewed.