Keywords
aspergillosis - clivus - intracranial abscess
Background: Aspergillus sp. is a common fungus that can be isolated from soil, building materials,
leaves, and foods. Involvement of skull base infection is unique and extremely uncommon
in immunocompetent patients. Through this report, we describe a case of invasive Aspergillosis
involving the sellar and clival region that manifested as a pituitary mass in an immunocompetent
middle-aged male with evidence of cranial nerve, hormonal disturbance, and rhinitis.
Case Report: An immunocompetent 53 years-old male with a history of diabetes experienced visual
field disturbance and VIth nerve palsy following progressive headaches. The Magnetic
Resonance Imaging (MRI) showed sinusitis at sphenoidal and right maxillary sinus,
bilateral mastoiditis and mass in the clival region. Surgical excision with an extended
endonasal endoscopic endonasal transclival approach was done. Pathological examination
indicated Aspergillosis with an active chronic inflammation in the capsule mass .
The patient then received IV voriconazole.
Conclusion: Aspergillosis involving sellar and clival region is still rare particularly in immunocompetent
patients. Differentiating the pathology preoperatively is quite challenging and frequently
mistaken for a sellar region tumor and could be potentially life-threatening. The
extended endoscopic endonasal transclival approach could provide safe removal and
a good prognosis followed by antifungal therapy.
