Mycotic aneurysm due to Aspergillus sinusitis

A previously healthy 22-year-old woman with no history of chronic sinusitis developed acute myeloid leukemia and was treated at our hospital. Three courses of induction chemotherapy were needed to achieve complete remission. During the induction period, neutrophil counts \500/lL lasted for 98 days in total. At first induction therapy, the patient developed febrile neutropenia, which was successfully treated with empirical antimicrobial treatment including meropenem, vancomycin, fluconazole, and voriconazole. After the second induction therapy in a lamina airflow isolation room without prophylactic agents against fungal infection, she again developed febrile neutropenia and presented with a headache and visual impairment. Gadolinium-enhanced T1-weighted magnetic resonance imaging of the brain suggested aspergillosis in the sphenoid sinus (Fig. 1a). Examination of cerebrospinal fluid and serological testing (e.g., b-D-glucan, galactomannan) showed no abnormalities. Surgical removal of sinus lesion for sinusitis was performed. Staining of sinusoidal tissue suggested infection with Aspergillus species (Fig. 1b). She was treated with voriconazole for invasive aspergillosis, followed by liposomal amphotericin B due to liver damage. Follow-up magnetic resonance angiography 2 months later showed a mycotic aneurysm in the left anterior cerebral