A diagnostic challenge of invasive sellar neuroaspergillosis in an immunocompetent patient

Abstract

The commonest differential for sellar space occupying lesion is tumor, and clinicians would rarely consider aspergillosis at this location in an immunocompetent patient. Hence, a high index of suspicion clinically and histological confirmation are required to reach the diagnosis. Here, we report a case of such, a 28-year-old immunocompetent male presented with headache, vomiting, and diplopia for 7 days without any history of convulsion, unconsciousness or nasal symptoms. His magnetic resonance imaging and computed tomography of the brain and pituitary gland were suggestive of a primary bone tumor or pituitary macroadenoma of the sellar region. He then underwent surgery, and intraoperative squash cytology, frozen section, and fine-needle aspiration cytology of aspirated pus revealed necrotizing granulomatous lesion of fungal etiology. Postoperative histopathology and special stains (periodic acid-Schiff, Gomori methenamine silver) confirmed invasive aspergillosis, and Aspergillus flavus was isolated by pus culture. The surgery was followed by systemic voriconazole therapy, and there were no further complications.