Aspergillus parasellar abscess mimicking radiation-induced neuropathy. Case report.

Abstract

BACKGROUND:

Transsphenoidal surgery is a safe procedure for treatment of pituitary adenomas. However, several complications, including post-surgical infection, are known. We describe a case of Aspergillus parasellar abscess that presented with cranial neuropathies following transsphenoidal surgery and radiosurgery. We initially diagnosed the case as radiation-induced neuropathies, which delayed the detection of Aspergillus.

CASE DESCRIPTION:

A 55-year-old man underwent transsphenoidal surgery for a pituitary adenoma that presented with pituitary apoplexy. Dexamethasone had been continuously administered for hypocortisolism probably caused by pituitary apoplexy. Four years later, radiosurgery was performed for a relapse in the right cavernous sinus. Another 4 years later, he developed painful right ophthalmoplegia, right ptosis, and bilateral visual impairment, successively. We initially suspected that the painful ophthalmoplegia and ptosis were because of radiation-induced cranial neuropathies; however, results of magnetic resonance (MR) imaging and his clinical course were not consistent with those of radiation-induced neuropathies. Therefore, we performed exploratory surgery that revealed a subdural abscess on the planum sphenoidale. Culture of a specimen grew Aspergillus fumigatus.

CONCLUSION:

Intracranial fungal abscess is a fatal complication unless it is treated early. It is thus important to consider the possibility of parasellar infection and differentiate it from radiation-induced cranial neuropathies when a patient presents with cranial neuropathies after transsphenoidal surgery and radiosurgery.

• Authors: T Endo, Y Numagami, H Jokura, H Ikeda, R Shirane, T Yoshimoto
• Journal: Surgical neurology (Surg Neurol) Vol. 56 Issue 3 Pg. 195-200 (Sep 2001) ISSN: 0090-3019 [Print] United States
• PMID: 11597652 (Publication Type: Case Reports, Journal Article)

Topics

• Abscess (etiology, mortality, pathology)
• Adenoma (surgery)
• Aspergillus fumigatus (isolation & purification)
• Cranial Nerve Diseases (pathology)
• Diagnosis, Differential
• Humans
• Magnetic Resonance Imaging
• Male
• Middle Aged
• Neuroaspergillosis (etiology, mortality, pathology)
• Pituitary Neoplasms (surgery)
• Postoperative Complications
• Sella Turcica (pathology, surgery)