# Invasive Mediastinal Aspergillosis in an 18-Year-Old Immunocompetent Female Leading to Stroke

## TL;DR

An 18-year-old healthy woman with invasive aspergillosis developed a stroke and died, highlighting the need for early suspicion of this infection.

## Contribution

The case emphasizes the importance of considering invasive aspergillosis in immunocompetent patients with persistent symptoms and eosinophilia.

## Key findings

- Invasive aspergillosis can occur in immunocompetent individuals and may present with non-specific symptoms.
- Delayed diagnosis led to a fatal outcome despite treatment initiation.
- Eosinophilia and persistent mediastinal/pulmonary symptoms should raise suspicion for aspergillosis.

## Abstract

We present a case of invasive pulmonary aspergillosis in an immunocompetent young female. An 18-year-old female presented with symptoms of a left-sided middle cerebral artery (MCA) stroke with right arm weakness and aphasia. Computed tomography (CT) brain confirmed the diagnosis of stroke. Further history revealed that the patient had been experiencing low-grade fevers with occasional shortness of breath for the past year. The blood work had eosinophilia at that time for which she was given mebendazole but saw little improvement. Chest X-rays showed upper lobe consolidation for which a tuberculosis (TB) workup was also done, which also came out negative. At the current presentation, she underwent further workup with echocardiography and eventual ultrasound-guided mediastinal biopsy that ultimately led to the correct diagnosis of aspergillosis. However, sadly, it was already too late for the patient who passed away one day after the commencement of the amphotericin B therapy. This paper hopes to decrease the threshold of clinical suspicion for invasive aspergillosis (IA) regardless of the immunity status of the patient, especially if they are presenting with an unrelenting mediastinal or pulmonary symptom complex in the setting of eosinophilia.