Primary pituitary aspergillosis responding to transsphenoidal surgery and combined therapy with amphotericin-B and 5-fluorocytosine: case report.
Pituitary abscess is an unusual cause of sella turcica enlargement. Because its presentation closely mimics that of a pituitary tumor, the condition is seldom recognized preoperatively. Most cases have been of bacterial etiology; however, a single patient with a primary mycotic pituitary abscess secondary to Aspergillus species has been reported. That patient died of diffuse Aspergillus meningoencephalitis following a transfrontal craniotomy. In the present case, a woman with primary pituitary aspergillosis survived her infection with virtually intact pituitary function following a transsphenoidal approach which avoided contamination of cerebrospinal fluid. Postoperative amphotericin-B and 5-fluorocytosine therapy probably contributed greatly to her survival. Factors that should alert the clinician to the presence of a pituitary abscess in a patient with sella turcica enlargement are prior episodes of meningitis, sinusitis, or cerebrospinal fluid abnormalities, including pleocytosis, depressed glucose, and elevated protein.
D000666:Amphotericin B / Q000627:therapeutic use*; D001228:Aspergillosis / Q000188:drug therapy / Q000601:surgery*; D001922:Brain Abscess / Q000188:drug therapy / Q000601:surgery*; D003596:Cytosine / Q000031:analogs & derivatives*; D004359:Drug Therapy, Combination; D005260:Female; D005437:Flucytosine / Q000627:therapeutic use*; D006801:Humans; D008875:Middle Aged; D010900:Pituitary Diseases / Q000188:drug therapy / Q000601:surgery*; D011184:Postoperative Period
D000666:Amphotericin B; D003596:Cytosine; D005437:Flucytosine