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Pituitary fossa aspergillosis - a rare, potentially life-threatening infectious disease that is due to similar clinical and radiographic often mistaken for a tumor of the pituitary. Determination of diagnostic features of the process will help early detection and selection of appropriate neurosurgical tactics and antifungal therapy. This article demonstrates a rare case of pituitary mycetoma caused by Aspergillus fumigatus, in immunocompetent women with prolonged headache. History of the disease within 3 months of the 90-year-old woman complained of generalized headache, loss of appetite and nausea. Contact, beautiful tattoos body temperature normal, stable hemodynamics. Neurological examination revealed no abnormalities. In the history of a few years before this hospitalization colon resection for early cancer and surgical treatment of melanoma. Suffers from hypertension. The woman did not have data for diabetes, HIV infection was conducted antitumor drug or bioimmunoterapii melanoma. There was a head injury. Of the medicines regularly takes only ramipril. Routine investigations, including full blood count, serum electrolytes, and C-reactive protein were normal. Analysis on the pituitary hormones did not reveal any pathology other than mildly elevated serum prolactin beautiful tattoos - 714 IU / ml at a rate of CT scans of the brain: the expansion of the sella turcica in the sphenoid sinus mucoperiosteal thickening with a linear calcification (Fig. 1A). Magnetic resonance imaging with contrast revealed the formation within the upper portion of the sphenoid sinus, through the defect bottom of the sella turcica associated with pituitary fossa, in maximum craniocaudal dimension size 12 mm (Fig. 1). Pituitary visualized as heterogeneously in T 1 - and T 2-in mode, and accumulates a heterogeneously gadolinium. Suggested the presence beautiful tattoos of pituitary tumors with downward growth, but thickening in the sphenoid sinus and calcification allowed mycetomas suspect. Despite the non-opioid analgesics reception, headache patient beautiful tattoos increased. beautiful tattoos Repeat MRI 3 weeks later showed extension of lesions, there were signs of violation of the diaphragm of the sella turcica, with extension to the lower surface of the optic chiasm (Fig. 2). Spent endoscopic transnasal transsphenoidal surgery with stereotactic-guided access. Removed the mucosa of the sphenoid sinus and anomalous yellow fabric with a loose rear wall of the sphenoid sinus. Morphologic study of frozen sections revealed fungal hyphae. In the postoperative period were treated with amphotericin-B. When culture biopsies obtained growth Aspergillus fumigatus and started therapy 400 mg / day vorikanazolom. After surgery, headache almost completely regressed, but there were visual and tactile hallucinations and hyponatremia 123 mmol / l. Probable cause of complications found deficiency syndrome of antidiuretic hormone (SIADH) as a result of surgical trauma beautiful tattoos pituitary fossa. Another possible cause could be a side effect of voriconazole, which is temporarily canceled. Appointed risperidone patient, eliminating hallucinations. Three months beautiful tattoos after the operation the patient did not show neurological complaints. The control MRI showed persistent mucoperiosteal thickening with postoperative changes in the sphenoid sinus, but no signs of mycetoma. Conclusions. Clinical case illustrates beautiful tattoos the need to include in the differential diagnosis of aspergilloma pathological formations of the sella turcica. Transsphenoidal intervention, along with antifungal therapy is crucial in ensuring the survival and achieve optimal results. http://mirvracha.ru
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