An Autopsy Case with Cerebral Hemorrhaging due to disseminated Aspergillosis During Glucocorticoid Therapy for Overlap Syndrome of Systemic Lupus Erythematosus and Systemic Sclerosis

Intern Med. 2019 Apr 1;58(7):1023-1027. doi: 10.2169/internalmedicine.1226-18. Epub 2018 Dec 18.

Abstract

We encountered a 60-year-old female patient who died of cerebral hemorrhage caused by disseminated aspergillosis during massive steroid therapy for overlap syndrome of systemic lupus erythematosus (SLE) and systemic sclerosis (SSc) and performed autopsy. Histologically, necrotizing vasculitis accompanied by Aspergillus hyphae was noted in the arterial wall of the region with cerebral hemorrhage and an abscess containing Aspergillus clumps was present in the lung, therefor we considered the cerebral hemorrhage caused by disseminated aspergillosis. For immunocompromised patients, it is desirable to perform treatment taking the possibility of deep mycosis into consideration, and when it is suspected, early therapeutic intervention may be useful.

Keywords: cerebral hemorrhage; disseminated aspergillosis; systemic lupus erythematosus; systemic sclerosis.

Publication types

  • Case Reports

MeSH terms

  • Aspergillosis / complications
  • Aspergillosis / diagnosis
  • Aspergillosis / drug therapy*
  • Autopsy
  • Cerebral Hemorrhage / diagnosis*
  • Cerebral Hemorrhage / etiology
  • Fatal Outcome
  • Female
  • Glucocorticoids / therapeutic use*
  • Humans
  • Immunocompromised Host
  • Lupus Erythematosus, Systemic / complications*
  • Lupus Erythematosus, Systemic / diagnosis
  • Lupus Erythematosus, Systemic / drug therapy
  • Middle Aged
  • Scleroderma, Systemic / complications*
  • Scleroderma, Systemic / diagnosis
  • Scleroderma, Systemic / drug therapy

Substances

  • Glucocorticoids