[Invasive aspergillosis of the sphenoid sinus as a differential diagnosis in lesions of the sellar region].

Source: PubMed, NCBI / U.S. National Library of Medicine

We present a case of a 60-year-old woman with a history of poorly controlled type 2 diabetes who came to the emergency room with severe headache, nausea, and vomiting that had been ongoing for one week. Her vision was progressing with decreased visual acuity and diplopia. A MRI of the brain and sellar region was ordered, which revealed a lesion occupying the sphenoid sinus. Biochemical parameters included leukocytosis, hyperglycemia, central hypothyroidism and hypogonadism. Considering these findings, an interdisciplinary approach was undertaken to initiate a diagnostic and therapeutic algorithm. A fungal infection was suspected, and the patient was admitted to the Otolaryngology Department for endoscopic nasal surgery. Fungal-like tissue with abundant hyphae and localized inflammation was found. Aspergillus flavus was isolated from the culture, and the patient completed medical treatment with voriconazole. Invasive aspergillosis of the sphenoid sinus is a very rare entity, generally associated with immunocompromised patients. It requires a high level of suspicion and timely treatment. Due to its clinical and imaging characteristics, it remains a challenge for the medical specialties involved in its study, such as clinical medicine, otolaryngology, images, and endocrinology.