Primary pituitary aspergillosis responding to transsphenoidal surgery and combined therapy with amphotericin-B and 5-fluorocytosine

Ramos-Gabatin, A.; Jordan, Richard M.

doi:10.3171/jns.1981.54.6.0839

Cited by 63 publications

(26 citation statements)

References 11 publications

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“…One elderly man developed chronic meningitis leading to optic neuropathy and paratrigeminal syndrome without any evidence of extracranial infection (158). An Aspergillus abscess of the pituitary presented as a tumor (159). Cavernous sinus thrombosis and occlusion of the internal carotid artery followed erosion through the sphenoid sinus in one patient (71).…”

Section: Invasive Pulmonary Infection Invasive Aspergillusmentioning

confidence: 99%

Aspergillosis

Bodey

Vartivarian

1989

Eur. J. Clin. Microbiol. Infect. Dis.

298

228

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Aspergillus spores are ubiquitous in the environment and may become concentrated in hospital ventilation systems. Colonization in normal hosts can lead to allergic diseases ranging from asthma to allergic bronchopulmonary aspergillosis. Normal hosts rarely develop invasive disease, which is primarily an infection of severely immunocompromised patients. The major predisposing factors for infection include prolonged neutropenia, chronic administration of adrenal corticosteroids, the insertion of prosthetic devices, and tissue damage due to prior infection or trauma. Since Aspergillus spp. are respiratory pathogens, the most common form of infection is pneumonia followed by sinusitis. Patients with preexistant cavitary disease may develop noninvasive aspergillomas. Most infections are caused by Aspergillus fumigatus. The organism is capable of invading across all natural barriers, including cartilage and bone. It has a propensity for invading blood vessels causing thrombosis and infarction. The diagnosis of pulmonary infection is usually difficult to establish because the organism is seldom cultured from sputum and can represent contamination in some cases. Therapy is immunocompromised hosts is less than satisfactory and amphotericin B is the only agent with significant activity. There is anecdotal evidence to suggest that the addition of 5-fluorocytosine to amphotericin B may be beneficial.

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Section: Invasive Pulmonary Infection Invasive Aspergillusmentioning

confidence: 99%

Aspergillosis

Bodey

Vartivarian

1989

Eur. J. Clin. Microbiol. Infect. Dis.

298

228

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“…10,26) However, long-term survivors have been reported on rare occasions. 3,6,[12][13][14][15]20,23) We encountered a case of aspergilloma in the prepontine cistern that responded to local administration of AmB using an Ommaya tube.…”

Section: Introductionmentioning

confidence: 99%

Local Administration of Amphotericin B Against Aspergilloma in the Prepontine Cistern-Case Report-

Nabika

Kiya

Satoh

et al. 2007

Neurol. Med. Chir.(Tokyo)

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A 21-year-old man presented with aspergilloma in the prepontine cistern that developed after treatment for cerebellar hematoma following rupture of an arteriovenous malformation. He became bedridden with neurological signs of tetraparesis, disturbed ocular movement, and bulbar palsy, despite alert consciousness. Repeat magnetic resonance imaging 1 year later revealed a space-occupying lesion in the prepontine cistern along the clivus. This multilobular enhanced mass lesion gradually enlarged towards the brainstem over the following 4 years, resulting in loss of spontaneous breathing and dependence on a mechanical respirator. Surgical treatment via a lateral suboccipital approach was selected to reduce the size of the mass lesion and confirm the diagnosis. Histological examination revealed the presence of Aspergillus fumigatus. Treatment with amphotericin B (1 mg/kg/day) and fluconazole (100 mg/kg/day) injected into the peripheral veins was initiated, but was stopped due to the appearance of renal dysfunction. An Ommaya tube was then inserted into the prepontine cistern via a transsylvian approach to provide high concentrations of amphotericin B around the granulomatous lesion. He gradually improved, corresponding to the decreased size of the aspergilloma just after surgery. Surgical reduction of granuloma combined with local administration of antifungal agent is a good treatment option in patients with aspergilloma refractory to systemic administration.

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“…As previously mentioned, a past history of meningitis, sepsis and sinusitis may suggest the diagnosis 8,21 . Rapid neurological deterioration in a patient with sellar tumor after a presumed bacteremia should point to the possibility of abscess formation 16 .…”

Section: Discussionmentioning

confidence: 99%

“…2,3 . Cases of mycotic abscesses have been reported due to Aspergillus 20,21 , Candida 22 , coccidiodomycosis 23 , histoplasmosis 24 and blastomycosis 25 . In contrast to bacterial pituitary abscesses, most fungal infections are associated with some type of immunosuppressed patients 18 .…”

Section: Discussionmentioning

confidence: 99%

Primary pituitary abscess: case report

Hanel

Koerbel

Prevedello

et al. 2002

Arq. Neuro-Psiquiatr.

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-Pituitary abscesses are potentially life-threatening lesions if not appropriately diagnosed and treated. The authors have operated on more than five hundred cases of pituitary tumors and only one represented a case of pituitary abscess. A 35-year-old woman was investigated for chronic frontal headache. CT scan showed a cystic sellar lesion with ring enhancement after contrast injection leading to an initial diagnosis of pituitary adenoma. She underwent a sublabial transsphenoidal approach to the pituitary gland. After dural opening, purulent material was obtained and no tumor or other associated lesion was detected. There was no evidence of current or previous septicemic illness, meningitis, cavernous sinus thrombosis or sinus infection. Cultures were negative. She was put on antibiotics and discharged after 4 weeks. Nowadays, 10 years after treatment, she is doing well, with no anterior pituitary hormone deficit. MRI shows a partially empty sella without residual lesion and the pituitary stalck is in the midline. The early diagnosis and adequate treatment of this life-threatening lesion may result in excellent prognosis.KEY WORDS: abscess, pituitary gland, hypophysis. Abscesso primário de hipófise: relato de casoRESUMO -Abscessos pituitários são lesões potencialmente graves se não diagnosticadas e tratadas de maneira apropriada. Os autores têm mais de 500 casos de tumores pituitários operados e apenas um único caso de abscesso pituitário. Uma mulher de 35 anos foi investigada por cefaléia frontal crônica. A tomografia computadorizada de crânio mostrou uma lesão selar cística com captação de contraste levando à hipótese diagnóstica inicial de adenoma hipofisário. A paciente foi submetida a um acesso sublabial transesfenoidal para a hipófise. Após abertura dural, foi encontrado material purulento sem sinal de tumor ou outra lesão associada. Não havia evidência de doença séptica prévia ou atual, meningite, trombose de seio cavernoso ou sinusite. Culturas foram negativas. A paciente foi submetida a tratamento com antibióticos e recebeu alta após 4 semanas. Atualmente, após 10 anos do tratamento, encontra-se sem déficit hormonal hipofisário anterior. Sua ressonância magnética de crânio mostra uma sela parcialmente vazia sem lesão residual, com o talo hipofisário na linha média. O diagnóstico e tratamento adequado desta lesão potencialmente grave pode resultar em excelente prognóstico. PALAVRAS-CHAVE: abscesso, glândula pituitária, hipófise.

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Primary pituitary aspergillosis responding to transsphenoidal surgery and combined therapy with amphotericin-B and 5-fluorocytosine

Cited by 63 publications

References 11 publications

Aspergillosis

Aspergillosis

Local Administration of Amphotericin B Against Aspergilloma in the Prepontine Cistern-Case Report-

Primary pituitary abscess: case report

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