http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15118891
1: Acta Neurochir (Wien). 2004 May;146(5):521-4. Epub 2004 Apr 08.
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Iplikcioglu AC, Bek S, Bikmaz K, Ceylan D, Gokduman CA.
Neurosurgery Clinic, Social Security Okmeydani Teaching Hospital,
Istanbul, Turkey.
acelal@doctor.com
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] |