Invasive aspergillosis of pituitary gland in an immunocompetent patient

Background: Invasive aspergillosis is a major cause of morbidity and mortality in immunosuppressed patients. This infection is caused by Aspergillus, a hyaline mold, which is the etiologic agent for many different manifestations. Patient: A 63 year old diabetic housewife woman, living in northern Iran, presented with the history of right eye ptosis after a mild head trauma since about 3 weeks ago. She had positive history of intermittent headache several weeks before ptosis. On physical examination, the patient was afebrile and other vital signs were normal. Brain MRI showed a pituitary mass measuring about 4 cm. Pathological study showed hyphae in favor of aspergillosis. Amphotericin B was started and after 10 days changed to itraconazole. Conclusion: It is important to consider fungal infection as a differential diagnosis of cerebral lesions even in the immunocompetent hosts. The clinical presentation of cerebral aspergillosis is nonspecific and is characterized by focal neurologic signs, alteration in mental status and headache.