Fungal infections of the CNS are almost always a clinical surprise. Aspergillus species although ubiquitous are more frequently observed in immuno-compromised individuals upon inhalation of conidia. Most of the fungal infections which happen in humans are opportunistic, mostly due to immunocompromised host. We present the case of a 14-year-old boy who presented to the Emergency Department of Aga Khan University Hospital, Karachi, with complaints of right-sided weakness of the body. This was a rapid-onset condition which was associated with gait disturbances and multiple episodes of vomiting. MRI head showed encapsulated Space Occupying Lesion with puss in the left frontal lobe with surrounding edema. The patient was planned for a craniotomy to remove an intracerebral abscess. Histopathology report revealed the presence of chronic granulomatous inflammation with necrosis and numerous septate hyphae. A fungus culture was run which confirmed the presence of heavy colonies of Aspergillus flavus. Fungal infections of the central nervous system are almost always a clinical surprise, have a subtle presentation and mistaken often as meningitis, brain abscess, or tumor. Any suspected lesion once removed should be sent for biopsy to rule out the presence of any fungal infection.

中文翻译：

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黄曲霉菌是免疫功能正常的小儿患者的意外占位性病变

中枢神经系统的真菌感染几乎总是一种临床惊喜。吸入分生孢子后，在免疫功能低下的个体中更常见地观察到曲霉菌种。在人类中发生的大多数真菌感染是机会性的，主要是由于免疫功能低下的宿主。我们介绍了一个14岁男孩的案例，该男孩因身体右侧无力而被送往卡拉奇阿加汗大学医院急诊科。这是一种快速发作的疾病，与步态障碍和多次呕吐有关。MRI头显示囊性占位性病变，左额叶有脓液，周围有水肿。计划对患者进行开颅手术，以清除脑内脓肿。组织病理学报告显示，慢性肉芽肿性炎症伴坏死和大量分隔菌丝。进行了真菌培养，证实存在黄曲霉的重菌落。中枢神经系统的真菌感染几乎总是临床上的意外，具有微妙的表现，常常被误认为是脑膜炎，脑脓肿或肿瘤。一旦将任何可疑的病灶切除，应送去进行活检，以排除任何真菌感染的存在。