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Abstract Details

Diagnostic Dilemma of Aspergillus Meningitis in Patients with Hepatitis C co-infection; A Case Series.
Infectious Disease
Infectious Disease Posters (7:00 AM-5:00 PM)
054
To describe the diagnostic and management challenges in immunocompromised patients co-infected with aspergillus and hepatitis C virus (HCV).
Aspergillus meningitis can occur in immunocompromised and immunocompetent patients. The diagnostic yield is only 39% in immunocompromised patients and 69% in immunocompetent patients. Diagnosis can be challenging, as repeated cerebrospinal fluid (CSF) cultures can be negative. Even with multiple cultures, the diagnostic yield is very low, sometimes requiring a tissue diagnosis. However, prompt recognition and treatment initiation are crucial to minimize morbidity. We present two cases of patients with history of IV drug abuse, who were coinfected with HCV and aspergillus.
A case series. Both of these patients were identified during their admission in the general neurology service and consent was obtained.
We present two young Caucasian IVDA patients who presented with fevers, headaches and altered mental status. Initially they were started on empiric antibiotics to cover for various pathogens. Their imaging and multiple negative CSF cultures led to a diagnostic dilemma. Due to progressive decline in their clinical course and to ascertain a diagnosis, a brain biopsy was obtained resulting in tissue diagnosis of fungal meningitis secondary to Aspergillus, with hyphae and granulomas. With appropriate anti-fungal treatment, there was some clinical improvement in one of the cases, but unfortunately for the second case, he had tetra paresis secondary to spinal arachnoiditis. 

In workup of chronic meningitis, Aspergillus infection should be strongly considered in patients with IVDA and HCV co-infection. HCV has independent neurological complications including transverse myelitis, however, both comorbidities together can cause different symptomatology, which at times is difficult to recognize thus leading to increase morbidity. Multiple CSF cultures are usually recommended, but a tissue diagnosis with biopsy is needed to decrease the morbidity and mortality in these patients. 
Authors/Disclosures
Joseph Seemiller, MD
PRESENTER 		Dr. Seemiller has nothing to disclose.
Kristi M. Anderson, DO (UF Health Jacksonville) Dr. Anderson has nothing to disclose.
Muhammad Taimur A. Malik, MD (St Lukes) Dr. Malik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Genetech . Dr. Malik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for Jansen . Dr. Malik has received personal compensation in the range of $500-$4,999 for serving on a Scientific Advisory or Data Safety Monitoring board for EMD serono. The institution of Dr. Malik has received research support from National MS Society .