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Isolated central nervous system Aspergillosis infection in a chronic lymphocytic leukemia patient on Ibrutinib: A case report

BACKGROUND: In patients at high risk of opportunistic infections who present with isolated. neurological symptoms, it is lifesaving to consider Central Nervous System Aspergillosis (CNS-A). Ibrutinib use in chronic lymphocytic leukemia (CLL) has previously been associated with CNS-A. We provide a ca...

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Autores principales: Le, Thuy-Hong, Kumar, Vikas, Gondal, Khubaib, Barnes, Martin, Siddique, Haseeb, Buttar, Barjinder, Kaell, Alan
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7041109/
https://www.ncbi.nlm.nih.gov/pubmed/32093604
http://dx.doi.org/10.1186/s12879-020-4894-2
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author Le, Thuy-Hong
Kumar, Vikas
Gondal, Khubaib
Barnes, Martin
Siddique, Haseeb
Buttar, Barjinder
Kaell, Alan
author_facet Le, Thuy-Hong
Kumar, Vikas
Gondal, Khubaib
Barnes, Martin
Siddique, Haseeb
Buttar, Barjinder
Kaell, Alan
author_sort Le, Thuy-Hong
collection PubMed
description BACKGROUND: In patients at high risk of opportunistic infections who present with isolated. neurological symptoms, it is lifesaving to consider Central Nervous System Aspergillosis (CNS-A). Ibrutinib use in chronic lymphocytic leukemia (CLL) has previously been associated with CNS-A. We provide a case report of a patient that presented with primary CNS-A on Ibrutinib therapy without any prior pulmonary or local paranasal signs of infection. CASE PRESENTATION: 74-year-old Caucasian male with CLL and no prior chemotherapy on ibrutinib for 6 months presented with three months of unsteady gait, occipital headache, and confusion. He has a history of pulmonary sarcoidosis on chronic prednisone 5 mg daily and chronic obstructive pulmonary disease (COPD). He was found to have a “brain abscess” on imaging. Emergent craniotomy confirmed Aspergillus and patient was treated with Voriconazole for 6 months. At six-month follow up, repeat magnetic resonance imaging (MRI) confirmed complete resolution of CNS lesion. CONCLUSIONS: Our case reinforces the importance of being vigilant for isolated CNS-A in CLL patients on ibrutinib who present with neurological symptoms and signs, without prior or co-infection of sino-pulmonary tissue.
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spelling pubmed-70411092020-03-02 Isolated central nervous system Aspergillosis infection in a chronic lymphocytic leukemia patient on Ibrutinib: A case report Le, Thuy-Hong Kumar, Vikas Gondal, Khubaib Barnes, Martin Siddique, Haseeb Buttar, Barjinder Kaell, Alan BMC Infect Dis Case Report BACKGROUND: In patients at high risk of opportunistic infections who present with isolated. neurological symptoms, it is lifesaving to consider Central Nervous System Aspergillosis (CNS-A). Ibrutinib use in chronic lymphocytic leukemia (CLL) has previously been associated with CNS-A. We provide a case report of a patient that presented with primary CNS-A on Ibrutinib therapy without any prior pulmonary or local paranasal signs of infection. CASE PRESENTATION: 74-year-old Caucasian male with CLL and no prior chemotherapy on ibrutinib for 6 months presented with three months of unsteady gait, occipital headache, and confusion. He has a history of pulmonary sarcoidosis on chronic prednisone 5 mg daily and chronic obstructive pulmonary disease (COPD). He was found to have a “brain abscess” on imaging. Emergent craniotomy confirmed Aspergillus and patient was treated with Voriconazole for 6 months. At six-month follow up, repeat magnetic resonance imaging (MRI) confirmed complete resolution of CNS lesion. CONCLUSIONS: Our case reinforces the importance of being vigilant for isolated CNS-A in CLL patients on ibrutinib who present with neurological symptoms and signs, without prior or co-infection of sino-pulmonary tissue. BioMed Central 2020-02-24 /pmc/articles/PMC7041109/ /pubmed/32093604 http://dx.doi.org/10.1186/s12879-020-4894-2 Text en © The Author(s). 2020 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Case Report
Le, Thuy-Hong
Kumar, Vikas
Gondal, Khubaib
Barnes, Martin
Siddique, Haseeb
Buttar, Barjinder
Kaell, Alan
Isolated central nervous system Aspergillosis infection in a chronic lymphocytic leukemia patient on Ibrutinib: A case report
title Isolated central nervous system Aspergillosis infection in a chronic lymphocytic leukemia patient on Ibrutinib: A case report
title_full Isolated central nervous system Aspergillosis infection in a chronic lymphocytic leukemia patient on Ibrutinib: A case report
title_fullStr Isolated central nervous system Aspergillosis infection in a chronic lymphocytic leukemia patient on Ibrutinib: A case report
title_full_unstemmed Isolated central nervous system Aspergillosis infection in a chronic lymphocytic leukemia patient on Ibrutinib: A case report
title_short Isolated central nervous system Aspergillosis infection in a chronic lymphocytic leukemia patient on Ibrutinib: A case report
title_sort isolated central nervous system aspergillosis infection in a chronic lymphocytic leukemia patient on ibrutinib: a case report
topic Case Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7041109/
https://www.ncbi.nlm.nih.gov/pubmed/32093604
http://dx.doi.org/10.1186/s12879-020-4894-2
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