Intraventricular mould infection suggestive of Aspergillosis in a 2-year-old child with successful clinical outcomes

Pediatric isolated central nervous system (CNS) mould infections are uncommon but potentially fatal if not promptly diagnosed and treated. Such invasive lesions usually present as abscesses in parenchymal locations. Although the newer azole antifungals have shown improved outcomes, treatment data are limited in the pediatric age group, especially in young children. We report a case of a very young child with an unusual location of mould infection, in the temporal horn of the lateral ventricle, managed successfully. The 2-year-old-male child with prior COVID-19 infection and no other apparent immune dysfunction presented with features of raised intracranial pressure. CT/MRI imaging demonstrated a left temporal horn cystic lesion. Following an initial non-diagnostic aspiration of the cyst contents, the child underwent excision of the lesion. The potassium hydroxide stain of the content revealed hyaline septate hyphae, but the fungal culture was sterile. Histopathology of the specimen was highly suggestive of aspergillosis. The child was adequately treated with voriconazole, and had excellent clinical outcome at 22-month follow up. Rarely, CNS mould infection can manifest as an intraventricular space occupying lesion in children. Such a differential must be borne in mind. In our case, the infection was possibly a COVID-19 sequelae. The case also highlights the potential for successful clinical outcomes with an early and aggressive voriconazole treatment in pediatric intracranial mould infections, most likely aspergillosis.