ISOLATED INVASIVE ASPERGILLOSIS OF THE SP HENOID SINUS

Isolated aspergillosis of the sphenoid sinus is a difficult diagnosis because the often misleading clinical manifestations of this rare dise ase develop late, We report a case of invasive aspergillosis uniquely involving the sphenoid sinus revealed by clinical features suggesting pseudotumor of the pituitary in an immunocompetent man, A 71-year-old man presented sudden onset palsy of the abductor nerve of the left eye , Neuroimaging suggested a pseudotumor of the pituitary, Sphenoid sinu sitis was discovered at surgery, The diagnosis of aspergillosis was pr ovided by the histology examination of the sphenoid mucosa, Despite me dical treatment with itraconazol alone then in combination with amphot ericine B, the infectious process progressed to the pituitary, the cav ernous sinus, the upper orbital fissue and the optic canal, Cure was f inally achieved after a second surgical procedure to drain and aerate the sphenoid sinus, Aspergillosis of the sphenoid sinus is usually dis covered due to neurological signs such as a cavernous sinus syndrome, pseudotumor of the pituitary or the orbit, Diagnosis is often made int raoperatively or at histology examination. Invasive forms almost alway s are seen in immunosuppressed subjects, In our case, the patient was immunocompetent and had no past history of sinusitis, The invasive sph enoid aspergillosis invaded bone tissue, the cavernous sinus and the m eninges.