Sphenoid Aspergilloma with Headache and Acute Vision Loss

Fungal infection is a rare pathology in the sphenoid sinus, and extension into the pituitary fossa with visual loss has only been described in a few reports in the literature. Following publication of a recent report of pituitary abscess by Candida glabrata, we describe our own experience with a similar pathology. In the present report, we overview a diabetic patient who sustained aspergilloma in his sphenoid sinus with extension to the pituitary fossa. Clinical presentations are discussed along with an emphasis on the role of endoscopic endonasal drainage of the abscess as the mainstay of treatment. Following administration of intravenous amphotericin B for 6 days, endoscopic drainage of the aspergillus abscess was done. Visual acuity improved immediately after the operation. At the 12-month follow-up visit, the improvement in visual acuity was maintained and magnetic resonance imaging showed no recurrence. Correction of the underlying immune deficiencies, administration of intravenous antifungal agents perioperatively, endoscopic endonasal drainage of abscess, and a meticulous debridement of necrotic material, followed by a course of oral antifungal medication, comprises the standard treatment protocol for a fungus ball (aspergilloma) of the sphenoid sinus. •Aspergillus fungus ball in the sphenoid sinus can present with acute vision loss and headache.•Endoscopic endonasal drainage of the abscess along with antifungal therapy constitutes the standard treatment protocol.