Rare Invasive Aspergillosis with Brain Abscess in a Non-Classically Immunosuppressed Patient: Pooled Analysis of Individual Patient Data (2000–2024)

Moksada Regmi¹Shikun Liu¹Yuwei Dai¹Jingyi Ye²Xiaodong Chen¹Jun Yang¹Chenlong Yang^1*

• ¹Center for Precision Neurosurgery and Oncology, Peking University Health Science Center, Beijing, China
• ²Peking University School of Economics, Beijing, China

Intracranial aspergillosis is uncommon but often lethal, especially in classically immunocompromised hosts. We report a 71-year-old man with poorly controlled diabetes (a non-classical risk factor) who developed bilateral frontal abscesses due to Aspergillus fumigatus. After an initial craniotomy with negative cultures and galactomannan, recurrent disease was confirmed by stereotactic biopsy with next-generation sequencing (NGS). Targeted azole therapy (voriconazole, isavuconazole) and multidisciplinary care led to marked clinical and radiographic improvement. We also pooled 343 published cases (2000–2024): overall mortality was 34.6%, and 21.8% among patients without classical immunosuppression (including some with non-classical factors such as diabetes). Improved survival in recent decades likely reflects earlier diagnosis and broader azole use, though inference is limited by case-based evidence. Early tissue diagnosis (including molecular testing), timely surgery when indicated, and CNS-penetrant azoles can yield favorable outcomes in non-classically immunosuppressed patients.