Background: In patients at high risk of opportunistic infections who present with isolated.\nneurological symptoms, it is lifesaving to consider Central Nervous System Aspergillosis (CNS-A). Ibrutinib use in\nchronic lymphocytic leukemia (CLL) has previously been associated with CNS-A. We provide a case report of a\npatient that presented with primary CNS-A on Ibrutinib therapy without any prior pulmonary or local paranasal\nsigns of infection.\nCase presentation: 74-year-old Caucasian male with CLL and no prior chemotherapy on ibrutinib for 6 months\npresented with three months of unsteady gait, occipital headache, and confusion. He has a history of pulmonary\nsarcoidosis on chronic prednisone 5 mg daily and chronic obstructive pulmonary disease (COPD). He was found to\nhave a â??brain abscessâ? on imaging. Emergent craniotomy confirmed Aspergillus and patient was treated with\nVoriconazole for 6 months. At six-month follow up, repeat magnetic resonance imaging (MRI) confirmed complete\nresolution of CNS lesion.\nConclusions: Our case reinforces the importance of being vigilant for isolated CNS-A in CLL patients on ibrutinib\nwho present with neurological symptoms and signs, without prior or co-infection of sino-pulmonary tissue.
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