Sphenoid Aspergilloma: Diagnosed as a Malignancy: A Case Report

Fungal Rhinosinusitis (FRS) is a relatively common, often misdiagnosed disease process of the paranasal sinuses [1-3]. The incidence of the disease is 37 million cases that encompass a wide spectrum of immune and pathological responses, including invasive, chronic granulomatous and allergic conditions. A recent attempt was made to classify the various types of fungal sinusitis [4]. The current schema still includes 1) invasive diseases (acute invasive, granulomatous invasive and chronic) FRS and 2) noninvasive disease (saprophytic fungal infections, fungal ball and fungus related eosinophilic FRS that includes AFRS (allergic fungal rhinosinusitis). Thus, FRS results from multiple of fungal genera, including Aspergillus species [1-8]. Aspergillus species are involved in invasive FRS in immunocompetent individuals [9-12]. In all cases the condition is refractory to antibiotic regimens and is improved with intranasal antifungals [2,13,14]. The use of corticosteroids should be limited because of the potential for suppression of the neutrophil migration and killing action on fungal spores and hyphae by both neutrophils and macrophages [15-17]. In addition, Aspergillus sinusitis can mimic malignant disease and even appear as pituitary tumor [18-20]. Presented herein is a case of a 55 year old woman who developed a sphenoid sinus infection by Aspergillus terreus. The infection was initially diagnosed and treated as a neuroblastoma and a pituitary adenoma. She had endoscopic surgery followed with radiation and chemotherapy based upon misdiagnosis. Of interest, A. terreus produces mycotoxins citreoviridin, citrinin, and territrems [21]. The bio-complexity of water-damaged indoor environments has been reviewed by two independent sources [22,23].