ODP317 Hypophysitis or No? A Rare Case of Bipolaris Fungal Sinusitis Causing Severe Pituitary Inflammation.

Abstract

Abstract Clinical case: A 28 year old male with uncontrolled diabetes mellitus presented to the hospital with severe, worsening holo-cephalic headache associated with fevers, light sensitivity which was unresponsive to pain medications. Initial CT of the brain showed severe paranasal sinus disease. Lumbar puncture was significant for elevated protein and cell count with neutrophilic predominance and negative CSF culture. Patient was empirically treated for meningitis. Due to no improvement in his symptoms, MRI brain with contrast was done that showed complete opacification of the left sphenoid sinus with partial opacification of the ethmoid sinus. Of note, heterogeneous enlargement and enhancement of pituitary gland including portion of distal infundibulum was seen with mild compression of optic chiasm. High dose dexamethasone was initiated. Pituitary workup revealed preservation of all axes including AM cortisol 36.5 mcg/dL (6.6mcg/dl- 33 mcg/dl), prolactin 2.9 ng/ml (2.1ng/ml-17.7ng/ml), TSH 1.4 uIU/mL (0.34-5.6 uIU/mL), FT4 0.99 uIU/mL (0.80-1.80 uIU/mL) with normal serum chemistry and hemodynamics. Repeat MRI brain showed sphenoid pyomucocele with infection extending to the sella, cavernous sinuses and anterior/middle cranial fossas. ENT surgery was emergently performed with surgical debridement of the sphenoid and ethmoid sinuses revealing green cement like debris causing posterior septal perforation from the pressure. Interestingly, ethmoid sinus fluid culture grew Bipolaris fungal species. Patient's condition gradually improved and he was discharged on oral itraconazole with steroid taper. The patient did not develop signs or symptoms of hypophysitis during his hospital course. Presentation: No date and time listed