Madam LPS, a 69 years old lady complained of left eye blurring of vision since January 2017. It was associated with left orbital swelling with chemosis, eye redness,
epiphora, several episodes of self-limiting
epistaxis and bilateral
ophthalmoplegia. Other neurological examinations and cerebellar systems were intact. Magnetic Resonance Imaging (MRI) Brain and Orbit were performed, depicting a sellar mass with suprasellar extension with blood investigations results showed
panhypopituitarism. She underwent bilateral orbital
decompression. Trans-nasal endoscopic biopsy showed suppurative granulomatous lesion, which cultured Candida Albicans and Candida Galbrata. She was started on antifungal and hormonal replacement
therapy for
panhypopituitarism. Unfortunately, she did not respond well to treatment as repeated MRI Brain on December 2018 showed increase in size of sellar mass causing
obstructive hydrocephalus and increasing size of left orbital lesion. She was counselled for another debulking surgery with a ventriculoperitoneal (VP) shunt. HPE taken were reported as chronic inflammatory process in favour to
fungal infection. Pituitary
infections may mimic pituitary mass. Some may exhibit symptoms of
panhypopituitarism as well. Thus, physical examination, MRI brain imaging as well as HPE of biopsy are important
aids to achieve diagnosis. Optimal treatment of fungal pituitary
abscess includes transsphenoidal surgery combined with antifungal
therapy.