Central nervous system aspergillosis was misdiagnosed as toxoplasma gondii encephalitis in AIDS: a case report

Background: Patients with acquired immunodeficiency syndrome (AIDS) tend to suffer from a complication of several central nervous system (CNS) infections owing to hypoimmunity. However, CNS aspergillosis (CNSAG) is extremely rare and difficult to diagnose, which makes it easily misdiagnosed. Case presentation: We have reported here a 47-year-old male AIDS patient with visual ghosting and no sweat development on the left head and face. He was accordingly diagnosed with toxoplasma gondii encephalitis (TE) in other hospitals, for which he received regular anti-toxoplasma gondii and anti-human immunodeficiency virus (anti-HIV) treatment. Then, the patient was transferred to our hospital due to lack of any improvement with the prescribed treatment. The patient's neurological examination revealed no abnormalities at admission, albeit only a slight change in the cerebrospinal fluid. His cranial magnetic resonance imaging (MRI) revealed multiple abnormal signals in the brain parenchyma, and his blood sample was positive for toxoplasma gondii IgG antibody. The initial diagnosis at our hospital was also TE. Considering the poor efficacy of anti-TE treatment, cerebrospinal fluid metagenomics next-generation sequencing (mNGS) was performed, but no pathogenic bacteria were detected. However, aspergillus fumigatus was detected in the cerebrospinal fluid with targeted next-generation sequencing (tNGS) and bronchofiberscope alveolar lavage fluid mNGS. The diagnosis was accordingly modified as CNSAG combined with his other clinical manifestations. After administering voriconazole anti-fungal therapy, the patient’s symptoms were relieved, with improved absorption of the intracranial lesions. Conclusions: The present case experience indicated the need for the clinicians to strengthen their understanding of CNSAG. Moreover, for patients with diagnostic difficulties, early mNGS and tNGS (using biological samples with only a few pathogens) were helpful for the early diagnosis and treatment, whereby the patients could achieve favorable outcomes.