A Case-report of Concurrent Pulmonary and Cerebral Lesions in a Patient with Polymyositis: Invasive Aspergillosis or Astrocytoma?

 Polymyositis is an idiopathic inflammatory myopathy that mainly manifests itself with muscle weakness. Patients with polymyositis have a higher risk of developing infections and malignancies. We report concurrent pulmonary and cerebral lesions in a polymyositis patient with many diagnostic challenges.

 A 56-year-old woman complained of a productive cough and dyspnea from two weeks ago. Her symptoms gradually progressed until a sudden loss of consciousness occurred. She was a known case of polymyositis and was treated with oral prednisolone. Imaging revealed concurrent pulmonary and cerebral lesions. Initially, the patient underwent empirical therapy. However, the patient underwent a bronchoscopy because she did not respond to treatment. Specimens obtained from respiratory secretions revealed branched septate hyphae, and the culture was positive for Aspergillus fumigatus. She was diagnosed with invasive aspergillosis, so we replaced the therapy with voriconazole. After three months, the lung lesions improved, but the number and extent of cerebral lesions increased. Finally, after a stereotactic biopsy, the patient was diagnosed with astrocytoma and became a candidate for radiotherapy.

 Patients with polymyositis are prone to contracting opportunistic infections and malignancies. Both of them can mimic each other and present diagnostic challenges to physicians. Thus, they should think about them for early diagnosis and timely treatment.