Pituitary aspergillosis in a kidney transplant recipient and review of the literature

Abstract

Pituitary aspergillosis is a very rare disease, documented in only 12 cases. Although seen in both immunocompetent and immunocompromised patients, serious invasive sequelae, such as meningoencephalitis and death, have been noted in immunocompromised patients. Immunocompromised patients are susceptible and require complex multidisciplinary care to contain the spread of infection and maximize outcomes. This is the first case report, to our knowledge, of pituitary aspergillosis in the setting of an organ transplant. A 68-year-old woman presented with cephalgia, left temporal hemianopsia, and ptosis. Non-contrast magnetic resonance imaging of the head revealed a sellar mass, which was believed to be a benign pituitary adenoma. She underwent trans-sphenoidal resection, and subsequent histopathologic examination showed aspergillosis. She was subsequently started on voriconazole. On postoperative day 3, she developed a left anterior cerebral artery ischemic stroke, likely from Aspergillus angioinvasion and occlusion. Her mental status declined further and she died when care was withdrawn.

Secondary headache due to aspergillus sellar abscess simulating a pituitary neoplasm: case report and review of literature

“…T2-weighted MRI image showing a regular hypo-intense zone into the hyper-intense process, may correspond to iron accumulation and be specific to aspergillus infection (Boutarbouch et al 2009 ; Kurita et al 1995 ; Li et al 2008 ; Petrick et al 2003 ). Contrast enhanced T1-weighted MRI showed the mass was of slight rim enhancement (Li et al 2008 ; Petrick et al 2003 ; Vijayvargiya et al 2013 ), which may suggest a chronic inflammation.…”

“…The most effective treatment of fungal sellar abscess is endoscopic trans-sphenoidal surgery. Craniotomy may increase the risk of subarachnoid spread of infection which may be lethal (Vijayvargiya et al 2013 ). In these reported cases, only 2 (Endo et al 2001 ; Goldhammer et al 1974 ) patients underwent frontal craniotomy, who were separately died from occlusion of ICA and fulminant fungal meningoencephalitis.…”