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Abstract:

Objective To investigate the etiology，clinical presentation，diagnosis and treatment of Intracranial aspergillosis after liver transplantation. Methods Clinical data，diagnosis and treatment of one case with intracranial aspergillosis after liver transplantation were analyzed and correlative literatures were reviewed. Results The patient suffered muscle twitching without obvious cause one month after liver transplantation with clear consciousness. Magnetic resonance image（MRI）of head showed space-occupying lesion with long T1 long T2 signal in the centre and iso T1 short T2 signal around in the right frontal lobe. After enhancing，the lesion showed ring-enhancement with center and low density shadow around no reinforced. Intracranial aspergillosis wasdiagnosed. Then monotherapy of tacrolimus（FK506）was used with withdrawl of mycophenolate mofetil（MMF）and glucocorticoid. The serum FK506 concentration was maintained at a low level，and caspofungin was administratedfor intracranial aspergillosis. The MRI of head showed no obvious changing in the right frontal lobe abscess after two weeks. In order to cure the intracranial infection，the patient underwent resection of the right frontal lobe abscess aftergeneral anesthesia. During the operation，an abscess with tough wall with the size of 1.5 cm×2.0 cm was seen，which was sent to the Department of Pathology after resection. The pathological findings revealed intracranial aspergillosis.After operation，we continued to administrate caspofungin to treat intracranial aspergillosis，and reviewed head CT scan regularly. The patient did not suffer recurrent convulsion and high fever after resection. One month later，head CT scan showed better postoperative brain change and the subcutaneous tissue swelling of the right cranial frontal reduced without other abnormalities. Then the patient was discharged after recovery. Conclusion Dueto intracranial aspergillosis infection，it is difficult to achieve effective inhibitory concentration of antifungal agent.So when the transplant recipient was infected with isolated intracranial aspergillosis，combining local resection with antifungal agent and reducing the dose of anti-rejection drugs may be the ideal treatment.