Successful treatment of multiple intracerebral aspergillosis with voriconazole alone in an Egyptian diabetic patient with autoimmune hemolytic anemia

Aspergillosis is a common fungus that lives in soil and decaying vegetation. Inhalation of the spores causes infection mostly in immunocompromised patients. Invasive aspergillosis has an extremely high mortality, and a definitive diagnosis requires histopathological evidence of deep tissue invasion or positive culture; however, this evidence is often difficult to obtain due to the critical nature of the patients in these situations. The sensitivity of culture in this setting is also low. The galactomannan test is a recent antigen-antibody serologic test that depends on detecting an antigen which is a molecule found in the cell wall of aspergillus species. A positive result supports the diagnosis of invasive aspergillosis. We present a case of multiple intracerebral brain abscesses in an immunosuppressed patient due to an aspergillus species diagnosed by the galactomannan test with an excellent response to the treatment with the novel voriconazole alone, without any surgical intervention, and the purpose is to alert the physicians, neurologists, and infectious disease specialists to consider the intracranial aspergillosis among the differential diagnosis of the acute onset encephalitis especially in immunocompromised patients as early diagnosis and treatment may be life-saving.