Disclosures: Natalia Miranda-Cantellops, MD: No financial relationships or conflicts of interest

Case Description: The patient presented to the hospital with new onset headache, diplopia, and right hemiparesis. He underwent an extensive work-up, which was consistent with fungal hemorrhagic meningoencephalitis, though the organism was not isolated. Treatment was initiated with amphotericin, and once stabilized, he was discharged to the IRF. He continued to have significant right hemiparesis, mild cognitive impairment, dysarthria, and fatigue. On admission, he required minimal assistance with mobility and most self-care, but his functional status declined precipitously in the setting of continued fevers and side effects from amphotericin, requiring a return to acute care.

Setting: Inpatient Rehabilitation Facility (IRF)

Patient: 44-year-old man with ulcerative colitis, treated with vedolizumab infusions Assessment/

Results: Cerebrospinal fluid cultures ultimately revealed the causative organism as Aspergillus versicolor. He clinically improved after his antifungal treatment was changed to voriconazole. He returned to the IRF for an additional eight days, and was ultimately discharged home 6 weeks after his initial admission. Follow-up MRI one month after initiation of voriconazole showed near resolution of his brain lesions. His weakness resolved. Now, three months later, he continues to receive outpatient therapies to address his endurance and higher-level cognitive impairments, but is currently functioning at a modified independent level. He continues to experience severe fatigue, which has responded very well to modafinil. He also developed right shoulder-hand syndrome, with excellent response to a stellate ganglion block.

Discussion: Meningoencephalitis due to Aspergillus infection is very rare, but is more common among immunocompromised patients. It is extremely difficult to diagnose, and as such, has a high case fatality rate. It may result in a number of neurological impairments in survivors, for which rehabilitation services are essential.

Conclusion: Despite the high morbidity and mortality associated with Aspergillus meningoencephalitis, good functional outcomes are possible with intensive rehabilitation and appropriate antifungal therapy.

Level of Evidence: Level V

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PM&R Meeting Abstracts - https://pmrjabstracts.org/abstract/the-rehabilitation-of-a-survivor-of-aspergillus-versicolor-meningoencephalitis-a-case-report/