A rare cause of headache in a liver transplant patient – a case report

Czech version

Authors: N. Kubánek ¹ ; S. Adamcová Selčanová ¹; D. Žilinčanová ¹ ; K. Šulejová ¹ ; D. Havaj ¹ ; A. Halaj ²; T. Koller ³ ; Ľ. Skladaný ¹
Authors‘ workplace: II. Interná klinika a HEGITO (Hepatologické, gastroenterologické a transplantačné oddelenie), SZU a FNsP F. D. Roosevelta Banská Bystrica ¹; Oddelenie rádiológie, FNsP F. D. Roosevelta Banská Bystrica ²; V. interná klinika LF UK a UN Bratislava ³
Published in: Gastroent Hepatol 2026; 80(2): 118-123
Category: Hepatology: Case Report
doi: https://doi.org/10.48095/ccgh2026118

Overview

Invasive fungal infections are among the serious infectious complications in liver transplant recipients, with high morbidity and mortality rates. Aspergillosis is the second most common invasive mycosis, and in most cases, occurs in a disseminated form involving multiple organs. Isolated CNS involvement is considered a rare complication. In this case report, we present a patient who underwent liver transplantation and developed headaches in the early post-transplant period, which were later accompanied by visual disturbances. Several months after the onset of symptoms, a definitive diagnosis was established only after histological examination of a lesion located on the sphenoid bone of the skull, confirming an infection caused by Aspergillus spp. The patient was started on antifungal therapy according to the infectious disease specialist’s recommendations, with subsequent frequent monitoring of immunosuppressant levels during outpatient follow-up.

Keywords:

liver transplantation – invasive fungal infections – aspergillosis

Sources

1. Adam R, Karam V, Delvart V et al. Evolution of indications and results of liver transplantation in Europe. A report from the European Liver Transplant Registry (ELTR). J Hepatol 2012; 57(3): 675–688. doi: 10.1016/j.jhep.2012.
04.015.

2. Agostini C, Buccianti S, Risaliti M et al. Complications in post-liver transplant patients. J Clin Med 2023; 12(19): 6173. doi: 10.3390/ jcm 12196173.

3. Senoner T, Breitkopf R, Treml B et al. Invasive fungal infections after liver transplantation. J Clin Med 2023; 12(9): 3238. doi: 10.3390/ jcm12093238.

4. Mahmoud DE, Hérivaux A, Morio F et al. The epidemiology of invasive fungal infections in transplant recipients. Biomed J 2024; 47(3): 100719. doi: 10.1016/ j.bj.2024.100719.

5. Farahani A, Ghiasvand F, Davoudi S et al. Invasive aspergillosis in liver transplant recipients, an infectious complication with low incidence but significant mortality. World J Transplant 2023; 13(5): 264 –⁠ 275. doi: 10.5500/ wjt.v13.
i5.264.

6. Melenotte C, Aimanianda V, Slavin M et al. Invasive aspergillosis in liver transplant recipients. Transpl Infect Dis 2023; 25(3): e14049. doi: 10.1111/ tid.14049.

7. Abbasi M, Ardakani SS, Fakhar N et al. Catastrophic brain aspergillosis after liver transplantation. Case Rep Transplant 2021; 2021 : 8626057. doi: 10.1155/ 2021/ 8626057.

8. Khodashahi R, Akhavan Rezayat K, Abdollahzade A et al. CNS fungal infections in liver transplantation. Arch Clin Infect Dis 2024; 19(1): e138411. doi: 10.5812/ archcid-138411.

9. Montenovo MI, Jalikis FG, Hoch B et al. A symptomatic de novo pheochromocytoma 23 years after liver transplantation: a case report and review of the literature. Case Rep Transplant 2014; 2014 : 934385. doi: 10.1155/ 2014/
934385.

10. Chen F, Zhao Y, Shen C et al. Next generation sequencing for diagnosis of central nervous system aspergillosis in liver transplant recipients. Ann Transl Med 2021; 9(13): 1071. doi: 10.21037/ atm-21-92.

11. Leung V, Stefanovic A, Sheppard D. Severe cerebral aspergillosis after liver transplant. Transpl Infect Dis 2010; 12(1): 51 –⁠ 53. doi: 10.1111/ j.1399-3062.2009.00461.x.

12. Pfeiffer CD, Fine JP, Safdar N. Diagnosis of invasive aspergillosis using a galactomannan assay: a meta-analysis. Clin Infect Dis 2006; 42(10): 1417 –⁠ 1427. doi: 10.1086/ 503427.

13. Eiden C, Peyrière H, Cociglio M et al. Adverse effects of voriconazole: analysis of the French Pharmacovigilance Database. Ann Pharmacother 2007; 41(5): 755 –⁠ 763. doi: 10.1345/ aph. 1H671.

14. Barchiesi F, Mazzocato S, Mazzanti S et al. Invasive aspergillosis in liver transplant recipients: epidemiology, clinical characteristics, treatment, and outcomes in 116 cases. Liver Transpl 2015; 21(2): 204 –⁠ 212. doi: 10.1002/ lt.24032.

15. Gemini. Prompt: Pacient po transplantácii pečene s invazívnou aspergilózou a postihnutím orgánov: pečeň, mozog, obličky, pľúca a koža. 2026 [online]. Dostupné z: https:/ / gemini.google.com.