Central nervous system aspergillosis in a child with medulloblastoma

This case report and literature review of previously published cases describe the rare complication of cerebral aspergillosis in paediatric neuro-oncology patients. A boy in early childhood with high-risk medulloblastoma developed recurrent episodes of febrile neutropenia, persistent headache and cerebrospinal fluid (CSF) pleocytosis following surgical resection and two courses of intensive chemotherapy. Despite broad-spectrum antibiotic therapy, the fever remained unresolved. He subsequently developed worsening headache along with ongoing CSF pleocytosis, raising suspicion of meningitis. Blood and cerebrospinal cultures were negative, and later, cerebral MRI revealed multiple ischaemic lesions and raised suspicion of large-vessel vasculitis with arterial occlusions. Regardless of adding methylprednisolone and amphotericin to the broad-spectrum antibiotic treatment, the boy developed hemiparesis, coma and seizures preceding death. Autopsy findings revealed cerebral aspergillosis and infiltration of inflammatory cells along the blood vessels.