Disseminated Aspergillosis After SARS-CoV-2 and BTK Inhibition: A Perfect Storm of Immunosuppression

Aspergillus, is a ubiquitous conidial fungus, which individuals are exposed to frequently. Central nervous system (CNS) involvement in immunocompromised individuals is seen most commonly through hematogenous dissemination from a primary pulmonary cavitation. Patients being treated with Bruton Tyrosine Kinase inhibitors have been observed to have disproportionately higher incidences of infection. We present a case of disseminated CNS aspergillosis in a 64-year-old man who initially presented with worsening respiratory distress and was eventually found to have multifocal brain lesions growing fungal hyphae. The case report aims to highlight the prevalence of invasive fungal infections, which can present with various manifestations in individuals undergoing treatment with immunomodulating agents, particularly Bruton Tyrosine Kinase inhibitors. It underscores the importance of maintaining a high clinical suspicion in these individuals, to provide timely treatment and prevent grave consequences.