The fatal rupture of an Aspergillus aneurysm of the cerebral artery that presented as a flu-like syndrome

Fever and headache are common problems encountered by emergency physicians. The diagnostic etiologies can range from benign conditions to life-threatening conditions. Subarachnoid hemorrhage from a ruptured intracranial aneurysm that was caused by an Aspergillus infection is a rare event with a high mortality rate. The central nervous system (CNS) Aspergillus infection should be considered as a differential diagnosis when an immunocompromised patient presents with fever and headache. We reported a 61-year-old male with the above presentations collapsed unexpectedly shortly after been seen by emergency physicians without any imminent signs. He was eventually diagnosed as having an Aspergillus infection of the central nervous system. The clinical manifestations of intracranial Aspergillus infection are subtle and highly variable in term of severity, onset and progression. Early detection is often difficult and even aggressive treatment often results in a drastic medical outcome, which has legal implications for the treating physicians. This case typifies the high stakes associated with the diagnostic challenges that are encountered by emergency physicians when evaluating immunocompromised patients who are experiencing flu-like symptoms.