Aspergillus pituitary abscess

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1: Acta Neurochir (Wien). 2004 May;146(5):521-4. Epub 2004 Apr 08.

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Aspergillus pituitary abscess.

Iplikcioglu AC, Bek S, Bikmaz K, Ceylan D, Gokduman CA.

Neurosurgery Clinic, Social Security Okmeydani Teaching Hospital,

Istanbul, Turkey. acelal@...

BACKGROUND: Pituitary abscess is rare and most of the cases are of

bacterial origin. True fungal pituitary abscess is extremely rare

only five cases have been reported. In this report, we present a

case of aspergillus pituitary abscess. Mortality rate in

intracranial aspergillosis is close to 100% especially in

immunsuppressed patients when undiagnosed and untreated. In focal

CNS aspergillosis total cure can be achieved in approximately 30% of

the cases by surgical drainage and intensive antifungal therapy.

Although this is the first reported case with magnetic resonance

imaging examination the definitive diagnosis was established only by

histopathological examination. CLINICAL PRESENTATION: A 42 year-old

man was referred to our hospital with the diagnosis of sellar

suprasellar mass accompanied by frontal headache and decreased

visual acuity. His medical history was insignificant. Physical

examination was normal and the patient was afebrile. The

neurological examination revealed bilateral papilledema and

bitemporal hemianopsia but no stiff neck and motor or sensory

deficit. In the light of MRI examination, the preoperative diagnosis

was pituitary abscess secondary to paranasal sinus infection or

hemorrhagic pituitary adenoma. INTERVENTION: The patient was

successfully treated by transsphenoidal surgery. Histopathological

examination of sphenoid sinus mucosa revealed normal mucosal

appearance with inflammation and histopathological examination of

the intrasellar mass resulted in the diagnosis of aspergillosis. All

cultures obtained from sphenoid sinus were reported as having no

growth. However in the second week after the operation fungal

culture of the intrasellar mass grew aspergillus. After 8 weeks of

amphothericine-B treatment, the patient was discharged. At the last

follow up examination two years after the operation, the patient was

symptom free with normal pituitary function. CONCLUSION: Aspergillus

pituitary abscess should be considered in the differential diagnosis

of a pituitary mass. The correct diagnosis of pituitary

aspergillosis can only be achieved by histopathological examination

because clinical and radiological findings including MRI are not

specific and culture results are obtained later. Immediately after

the diagnosis, intensive antifungal therapy should be started for a

successful treatment. Copyright 2004 Springer-Verlag

PMID: 15118891 [PubMed - in process]