The incidence of serious fungal disease in the Indian population is 4.1%, with an attributable mortality of invasive aspergillosis of 58.8%. Still, the definite incidence of cerebral aspergillosis is not known due to underdiagnosis. We present a case of an 11-year-old male in the induction phase of early T-cell precursor acute lymphoblastic leukaemia who was admitted to the intensive care unit with neutropenic enterocolitis. He was managed with fluids, vasopressors and antibiotics. He improved by day 6 but suddenly deteriorated with a low Glasgow coma scale the next day. An urgent computed tomography scan showed hypodense lesions in the right putamen and left thalamus. He was evaluated for meningitis, septic emboli, intracranial bleed, leukaemic infiltration or septic encephalopathy. Unfortunately, day 11 magnetic resonance imaging brain study confirmed fungal abscesses, when he failed to show improvement. We aim to highlight this rapid deterioration. The prognosis of invasive aspergillosis largely depends on early diagnosis, the extent of invasion and the host’s immune status. A high index of suspicion is essential to identify early signs, as many conditions can mimic its presentation.
Sharma et al. (Thu,) studied this question.