Intracranial Aspergillosis in an Immunocompetent Young Woman Prasan Kumar Panda . Sunil Kumar Mavidi . Naveet Wig . Ajay Garg . Aasma Nalwa . M. C. Sharma Received: 16 September 2016 / Accepted: 16 December 2016 Ó Springer Science+Business Media Dordrecht 2017 Abstract Intracranial aspergillosis (ICA) is very rare in the immunocompetent individuals, usually misdiagnosed as a tumor or an abscess. A high index of clinical suspicion is required in patients who present with focal neurological deficits, headache, or seizures. We report the case of a 25-year-old immunocompetent female, who presented with a 15-month history of headache, seizures, left-sided proptosis and ophthal- moplegia, and right hemiparesis. Recovery from the symptoms and decrease in the lesion size seen on the radiological assessment were achieved through two decompressive craniotomies followed by prolonged combined systemic antifungal therapies. Although the initial neuroimaging suggested a mitotic pathology, the surgical sample confirmed ICA. Now the patient is on single antifungal therapy (Tab. voriconazole, 200 mg twice daily) and doing her daily activities, but with a reduced intelligent quotient. We report a challenging case of ICA where multiple courses of combined antifungal therapies and repeat surgeries paved the way for a good prognosis. Keywords Combined antifungal therapies Á Craniotomy Á Intracranial aspergilloma Á Invasive aspergillosis Á Invasive fungal disease Introduction Aspergillus is a saprophytic opportunistic ubiquitous mold/fungus found in the soil, water, and plants, and it grows on decaying vegetative matter. With varying incubation periods of 2–90 days, the organism enters the human host via an inhalation route or breaching the skin [1]. It affects a local organ or disseminates in the form of invasive aspergillosis (IA) depending upon the severity of the immunocompromised state [2]. Intracranial aspergillosis (ICA) is a form of IA, occurs more frequently in immunocompromised indi- viduals, and takes either an acute or chronic course depending on the immune status of the patient and the mechanism of disease spread. The most common clinical symptoms are headache, fever, altered mental status, and seizures. Pathologically, it may present as meningitis, meningoencephalitis, abscess, granuloma, vasculitis (as thrombosis, hemorrhage, or aneurysm formation), and myelitis [3]. Imaging, histopathology, and isolation of the fungus from the cerebrospinal fluid (CSF) or tissue sample are useful in the diagnosis; P. K. Panda Á S. K. Mavidi Á N. Wig (&) Department of Internal Medicine, All India Institute of Medical Sciences, Ansari Nagar, New Delhi 110029, India e-mail: naveet_wig@yahoo.com A. Garg Department of Neuro-Radiology, All India Institute of Medical Sciences, New Delhi, India A. Nalwa Á M. C. Sharma Department of Pathology, All India Institute of Medical Sciences, New Delhi, India 123 Mycopathologia DOI 10.1007/s11046-016-0106-4