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Choi E, Kim SB, Kim JH, Yoon YK. Lung aspergilloma with pituitary invasive aspergillosis presenting as headache and hyponatraemia. BMJ Case Rep 2021; 14:14/1/e238721. [PMID: 33504528 PMCID: PMC7843313 DOI: 10.1136/bcr-2020-238721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/29/2023] Open
Abstract
Fungal infections involving the pituitary gland are rare and can be life threatening. A 75-year-old man with hypertension and diabetes mellitus presented with headache and hyponatraemia. Imaging study showed right upper lung mass, and mass resection showed aspergilloma without tissue invasion on histology. The patient developed visual impairment a few weeks later, and MRI of the brain revealed bilateral sphenoid sinusitis and pituitary invasion. The trans-sphenoidal biopsy confirmed invasive Aspergillus infection. His sphenoidal sinuses were endoscopically debrided, and he was treated with oral voriconazole. Pituitary aspergillosis should be considered in the differential diagnosis in patients with lung aspergilloma with headache and sinusitis. Prompt biopsy and antifungal treatment are important due to the high mortality rate of the infection.
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Affiliation(s)
- Eunho Choi
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Sun Bean Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jong Hun Kim
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
| | - Young Kyung Yoon
- Division of Infectious Diseases, Department of Internal Medicine, Korea University College of Medicine, Seoul, Republic of Korea
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Ray S, Balaini N, Chakravarty K, Pattanayak S, Goel A, Takkar A, Lal V. Special scenarios in the management of central nervous system aspergillosis: a case series and review of literature. Postgrad Med J 2019; 95:382-389. [DOI: 10.1136/postgradmedj-2018-136095] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Revised: 01/14/2019] [Accepted: 04/07/2019] [Indexed: 12/12/2022]
Abstract
Aspergillus is a rare but important opportunistic pathogen to invade the central nervous system (CNS). It is a significant pathogen of not only immunocompromised but also immunocompetent patients. Its manifestations are pleiotropic, reflecting multiple mechanisms of pathogenesis and host interactions. Despite significant advances in diagnostic methods and therapeutic options, the mortality remains high. Several advances have been made in medications and surgical management, yet, current treatment practices lack uniformity. Patient woes are further heightened by the high costs of treatment and prolonged duration of therapy. In view of the challenging aspects of this disease, we present a short review of four challenging cases touching on the varied aspects of management of CNS aspergillosis covering pathogenesis, diagnostic pitfalls, surgical and medical options and evidence-based guidelines for the management of the same.
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Moore LA, Erstine EM, Prayson RA. Pituitary aspergillus infection. J Clin Neurosci 2016; 29:178-80. [PMID: 26896907 DOI: 10.1016/j.jocn.2016.01.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2016] [Accepted: 01/17/2016] [Indexed: 11/18/2022]
Abstract
Fungal infection should be considered in the differential diagnosis of a pituitary or sellar mass, albeit fungal infections involving the pituitary gland and sella are a rare occurrence. We report a case of Aspergillus infection involving the pituitary gland and sellar region discovered in a 74-year-old man. The patient had a history of hypertension, chronic renal disease, autoimmune hemolytic anemia and presented with right eye pain, headaches and worsening hemiparesis. Imaging studies revealed a right internal carotid artery occlusion and an acute right pontine stroke along with smaller infarcts in the right middle cerebral artery distribution. Clinically, the patient was thought to have vasculitis. An infectious etiology was not identified. He developed respiratory distress and died. At autopsy, necrotizing meningitis was discovered. A predominantly chronic inflammatory cell infiltrate consisting of benign-appearing lymphocytes, plasma cells and macrophages was accompanied by acute angle branching, angioinvasive hyphae which were highlighted on Gomori methenamine silver staining and were morphologically consistent with Aspergillus species. In previously reported cases of Aspergillus infection involving the pituitary or sella, most presented with headaches or impaired vision and were not immunocompromised. A transsphenoidal surgical approach is recommended in suspected cases in order to minimize the risk of dissemination of the infection. Some patients have responded well to antifungal medications once diagnosed.
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Affiliation(s)
- Lauren A Moore
- Cleveland Clinic Department of Anatomic Pathology, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Emily M Erstine
- Cleveland Clinic Department of Anatomic Pathology, 9500 Euclid Avenue, Cleveland, OH 44195, USA
| | - Richard A Prayson
- Cleveland Clinic Department of Anatomic Pathology, 9500 Euclid Avenue, Cleveland, OH 44195, USA.
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Hong W, Liu Y, Chen M, Lin K, Liao Z, Huang S. Secondary headache due to aspergillus sellar abscess simulating a pituitary neoplasm: case report and review of literature. SPRINGERPLUS 2015; 4:550. [PMID: 26435896 PMCID: PMC4582039 DOI: 10.1186/s40064-015-1343-6] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Accepted: 09/15/2015] [Indexed: 11/10/2022]
Abstract
Fungal sellar abscess is rare. A 42-year-old man was admitted with 2-month headache characterized by right peri-orbital pain. An intrasellar mass was found to be simulated a pituitary neoplasm after magnetic resonance imaging examination, and operated on via an endoscopic trans-sphenoidal approach. Milk-like pus and a mass of ash black mixed and necrotic material were found and removed. Histopathology revealed numerous aspergillus hyphae. Itraconazole was given on a dosage of 200 mg twice a day orally for 6 weeks. No recurrence was observed during follow-up. Complete surgical resection through endoscopic trans-sphenoidal approach combined with systemic anti-fungal therapy, should be considered as the optimal treatment.
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Affiliation(s)
- Wenyao Hong
- Department of Neurosurgery, Fujian Provincial Hospital, Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, 350001 China
| | - Yuqing Liu
- Department of Neurosurgery, Fujian Provincial Hospital, Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, 350001 China
| | - Mingwu Chen
- Department of Neurosurgery, Fujian Provincial Hospital, Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, 350001 China
| | - Kun Lin
- Department of Neurosurgery, Fujian Provincial Hospital, Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, 350001 China
| | - Zhengjian Liao
- Department of Neurosurgery, Fujian Provincial Hospital, Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, 350001 China
| | - Shengyue Huang
- Department of Neurosurgery, Fujian Provincial Hospital, Fujian Medical University, 134 Dongjie Road, Gulou District, Fuzhou, 350001 China
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Damle NA, Patwardhan VV, Arora A. Incremental value of SPECT/CT over planar bone scan in the evaluation of skull base osteomyelitis: A potentially fatal disease in diabetics. Indian J Endocrinol Metab 2013; 17:1128-1129. [PMID: 24381900 PMCID: PMC3872701 DOI: 10.4103/2230-8210.122649] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Affiliation(s)
- Nishikant A. Damle
- Nuclear Medicine Division, NCR MRI and Diagnostics, Faridabad, Haryana, India
| | | | - Arundeep Arora
- Department of Radiodiagnosis, A.I.I.M.S, New Delhi, India
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Shama SA. Osteomyelitis of the central skull base: Otogenic and odontogenic sources. Multidetector CT study. THE EGYPTIAN JOURNAL OF RADIOLOGY AND NUCLEAR MEDICINE 2012. [DOI: 10.1016/j.ejrnm.2012.07.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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Bouccara D, Simon-Blancal V, Rodallec M, Cyna-Gorse F, Mosnier I, Fantin B, Sterkers O. Ostéomyélite de la base du crâne d'origine otosinusienne. Étude d'une série de cinq cas récents. ACTA ACUST UNITED AC 2007; 124:25-32. [PMID: 17307132 DOI: 10.1016/j.aorl.2006.11.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2006] [Accepted: 11/21/2006] [Indexed: 11/16/2022]
Abstract
INTRODUCTION Skull base osteomyelitis is an uncommon but severe condition generally secondary to necrotizing otitis externa. The aim of this study was to determine the patients demographics, clinical and radiological findings, and outcomes of this condition. MATERIAL AND METHODS We prospectively follow 5 patients with a diagnosis of skull base osteomyelitis between 2004 and 2005. Clinical, biologic and imaging data were collected, and also follow-up during treatment. RESULTS The five patients were men and the average age at presentation was 75 years (63-89). All except one had a previous diabetes mellitus, with a more or less recent clinical story of otitis externa. All of them suffered of headaches and cranial nerve(s) deficits, particularly facial nerve. Diagnosis was made on MRI with gadolinium injection and fat saturation, and Pseudomonas aeruginosa identified as pathogen in all cases. One patient deceased of cranial nerves palsy complication. In 4 cases we found previously a too short or non adapted treatment of necrotizing otitis externa. CONCLUSIONS In the setting of headache, cranial nerves deficit and abnormal skull base imaging on MRI with Fat sat, osteomyelitis should be consider as the likely diagnosis. This complication should be avoided by optimal management of necrotizing otitis externa.
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Affiliation(s)
- D Bouccara
- Service d'ORL, hôpital Beaujon, APHP, université Paris-VII, 100, boulevard du Général-Leclerc, 92110 Clichy, France.
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Choi PR, Yu HJ, Yang SW, Kim GJ, Rim H, Kim YR, Choi YS, Park YH, Chun BK. A Case of Pituitary Mucormycosis in Diabetic Patient with Acromegaly and Gastric Cancer. ACTA ACUST UNITED AC 2006. [DOI: 10.3803/jkes.2006.21.3.245] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Affiliation(s)
- Pyoung Rak Choi
- Department of Internal Medicine, Kosin University College of Medicine, Korea
| | - Hong Jun Yu
- Department of Internal Medicine, Kosin University College of Medicine, Korea
| | - Seung Wu Yang
- Department of Internal Medicine, Kosin University College of Medicine, Korea
| | - Gyu Jong Kim
- Department of Internal Medicine, Kosin University College of Medicine, Korea
| | - Hark Rim
- Department of Internal Medicine, Kosin University College of Medicine, Korea
| | - Yu Ri Kim
- Department of Internal Medicine, Kosin University College of Medicine, Korea
| | - Young Sik Choi
- Department of Internal Medicine, Kosin University College of Medicine, Korea
| | - Yo Han Park
- Department of Internal Medicine, Kosin University College of Medicine, Korea
| | - Bong Kwon Chun
- Department of Pathology, Kosin University College of Medicine, Korea
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Abstract
Whilst pituitary adenomas are the commonest cause of a sellar mass, there are a number of other neoplastic, infectious, inflammatory, developmental and vascular aetiologies that should be considered by the radiologist. We discuss and illustrate these lesions and indicate the various magnetic resonance imaging features that are helpful in formulating an appropriate differential diagnosis.
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Affiliation(s)
- S E J Connor
- Department of Neuroradiology, King's College Hospital, London, U.K.
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