Aspergillus flavus as a surprise space occupying lesion in an immunocompetent pediatric patient

Background Fungal infections of the CNS are almost always a clinical surprise. Aspergillus species although ubiquitous are more frequently observed in immuno-compromised individuals upon inhalation of conidia. Most of the fungal infections which happen in humans are opportunistic, mostly due to immunocompromised host. Case description We present the case of a 14-year-old boy who presented to the Emergency Department of Aga Khan University Hospital, Karachi, with complaints of right-sided weakness of the body. This was a rapid-onset condition which was associated with gait disturbances and multiple episodes of vomiting. MRI head showed encapsulated Space Occupying Lesion with puss in the left frontal lobe with surrounding edema. The patient was planned for a craniotomy to remove an intracerebral abscess. Histopathology report revealed the presence of chronic granulomatous inflammation with necrosis and numerous septate hyphae. A fungus culture was run which confirmed the presence of heavy colonies of Aspergillus flavus . Conclusion Fungal infections of the central nervous system are almost always a clinical surprise, have a subtle presentation and mistaken often as meningitis, brain abscess, or tumor. Any suspected lesion once removed should be sent for biopsy to rule out the presence of any fungal infection.