Cerebral Aspergillus penicillioides infection mimicking schwannoma in an immunocompetent host: case report with a review of the literature

Background: Central nervous system aspergillosis is a rare and severe condition with high mortality and frequent diagnostic delay. Infection due to Aspergillus penicillioides in this setting is rarely reported. Case presentation: We describe a rare case of cerebral infection caused by A. penicillioides in an immunocompetent patient, initially mistaken for a schwannoma. Histopathological examination revealed hyaline septate hyphae, and molecular analysis of formalin-fixed and paraffin-embedded (FFPE) tissue supported the identification by sequencing of a fragment of the 28S rRNA gene. Following an initial surgical resection, clinical deterioration ensued, necessitating a repeat procedure and targeted antifungal therapy, which ultimately led to disease stabilization and outpatient discharge. Conclusion: This case highlights the diagnostic difficulties and therapeutic challenges posed by rare Aspergillus species in immunocompetent hosts.