Aspergillosis of the sphenoid sinus simulating pituitary apoplexy: A case report

Aspergillosis of the sphenoid sinus is uncommon. It may be life- threatening if intracranial invasion occurs, particularly in an immunocompromised patient. A 65-year-old immunocompromised male patient with sphenoid sinus aspergillosis simulating pituitary apoplexy is presented. The clinical presentation included the sudden onset of a severe headache and blurred vision. Preoperative skull X-rays and brain computed tomographic scans showed enlarged sella turcica. However, sagittal magnetic resonance images revealed a lesion in the sphenoid sinus with an intact pituitary gland. Surgery was performed using the transsphenoidal approach. Pus and necrotic debris were found intraoperatively. The histological examination of surgical specimens revealed a fungal infection which is consistent with aspergillosis. Amphotericin B therapy was given for six weeks postoperatively. The patient was free of this disease during a 10-month follow-up period. We conclude that the preoperative differential diagnosis of a pituitary tumor in an immunocompromised patient should include sphenoid sinus fungal infection. The treatment of choice is radical surgical removal as early as possible combined with systemic amphotericin B. The important and characteristic findings of sagittal magnetic resonance image in the diagnosis of this disease are discussed.