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CASE REPORT
Year : 2021  |  Volume : 54  |  Issue : 3  |  Page : 111-113

A diagnostic challenge of invasive sellar neuroaspergillosis in an immunocompetent patient


1 Department of Pathology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India
2 Department of Neurosurgery, Institute of Medical Sciences and SUM Hospital, Bhubaneswar, Odisha, India

Correspondence Address:
Pranita Mohanty
Department of Pathology, Institute of Medical Sciences and SUM Hospital, Bhubaneswar - 751 003, Odisha
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/fjs.fjs_194_20

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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.


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