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Neuroaspergillosis is mostly reported in immunocompromised patients with a mortality rate near 100%.1 Only 16 cases have been reported in immunocompetent patients with a low mortality rate (two of 16).1 2 Tuberculomas of the brain constitute 0.15% of all intracranial space occupying lesions in western countries. We describe the first known case of neuroaspergillosis associated with neurotuberculosis in an immunocompetent patient successfully treated with itraconazole and antituberculous therapy.
A 42 year old Djiboutian woman, living in France since 1973, was admitted to hospital for partial seizures after a one month history of fatigue and 5 kg weight loss (42 kg). She had no previous history of immunodeficiency, transplantation, cancer, long term chemotherapy, or other chronic illness. The patient had no identifiable risk factors for AIDS. On admission, physical examination disclosed fever (⩾38°C), a left sided hemiparesis, and a nystagmus. Routine laboratory tests were normal, as were serum globulin, rheumatoid factor, antinuclear antibodies, anti-native DNA antibodies, anti-SS-A and anti-SS-B antibodies, anti-Sm antigen, antineutrophil cytoplasmic antibodies, circulating immune complexes, serum complement, and antithyroid antibodies. Although she had never received BCG vaccination, the tuberculin skin test showed an induration of 14 mm. A serological test for human immunodeficiency virus …