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Issue: Issue 3 (2016) – Supplement 3


Case Report

Tumour-like lesion of the central nervous system: an elusive cause

Author(s):
Ana Monteiro, Bruno Carvalho, Cátia Caldas, António Sarmento, Rui Vaz, and Joana Guimarães
Abstract:
Introduction: Several central nervous system (CNS) disorders may present with a tumour-like mass mimicking brain tumour, including infections and vasculitis of the CNS. 
Case Report: We report the case of a previously healthy 61-year-old woman presenting with paraphasia. MRI showed a large left temporal, ill-defined lesion with heterogeneous signal intensity on both T1W and T2W images, and heterogeneous contrast enhancement, surrounded by oedema, suggestive of a high-grade glioma. Surgery was performed, but the pathology of the tissue was negative for neoplastic tissue and suggested chronic inflammation. Two months later she presented with progressively worsening neurological signs, and a repeat MRI revealed extensive re-growth of the lesion. In the absence of a definitive diagnosis, a second surgical approach was undertaken. Pathological examination now suggested, additionally, chronic non-granulomatous vasculitis. Pseudotumor form of primary angiitis of the CNS was considered. However, after specific DNA probing, Aspergillus fumigatus was found present in both the biopsy tissue and peripheral blood samples. 
Discussion: Aspergillus fumigatus is a common fungus that rarely infects the CNS. Immunocompromised patients are more commonly infected, although there have been several reports in immunocompetent patients, usually presenting as a mass lesion. Due to the unspecific imaging appearance pseudotumor masses pose a real diagnostic challenge.

Keywords: Pseudotumor, Vasculitis, Aspergillus fumigatus.

Special Issue on Inflammatory Demyelinating Diseases of the Central Nervous System

International Journal of Clinical Neurosciences and Mental Health 2016; 3(Suppl. 3):S09
DOI: http://dx.doi.org/10.21035/ijcnmh.2016.3(Suppl.3).S09
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