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55-year-old man with past medical history of chronic lymphocytic leukemia presents with headache. Neuroimaging shows multiple ring-enhancing lesions in the brain.
CNS involvement by fungal organisms such as Aspergillus is typically a complication of systemic disease, most often occurring in immunocompromised patients. Organisms may spread to the CNS hematogenously, typically following pulmonary disease, or may directly invade the CNS following sinonasal infection. The outcome is poor in many patients, even with treatment. Microscopically, Aspergillus shows dichotomous, acute-angle branching hyphae that stain positively with PAS and GMS. However, correlation with tissue culture is essential, and in this case Aspergillus fumigatus was confirmed. The inflammatory reaction in the adjacent brain varies depending on the immunocompetency of the patient.