True XXXX in a @entity1 with gonadotropinoma after trans-sphenoidal surgery.

@entity1 @entity5880 @entity510 @entity384 @entity693 @entity2381 @entity5254 @entity397 @entity1188 @entity977 @entity3 @entity364 @entity715 @entity1332
BACKGROUND: Immunosuppressive therapy, prolonged antibiotic use, and intrathecal injections are known risk factors for the development of @entity3 . Central nervous system (CNS) @entity2381 can manifest in many forms, including @entity5880 formation. The majority of the @entity5880 presents with @entity510 after @entity397 and are associated with high mortality. Only 3 cases of true @entity5880 have been reported following trans-sphenoidal surgery. CASE DESCRIPTION: A 38-year-old @entity1 was admitted with nonfunctioning @entity977 for which he underwent trans-sphenoidal surgery. Three weeks later, he presented with cerebrospinal fluid (CSF) @entity5254 and @entity693 . He was treated with intrathecal and intravenous antibiotics, stress dose of glucocorticoids, and lumbar drain. The defect in the sphenoid bone was closed endoscopically. After 3 weeks of therapy, he suddenly became unresponsive, and computed tomography of the head showed @entity510 . He succumbed to illness on the next day, and a limited autopsy of the brain was performed. The autopsy revealed extensive @entity510 and @entity384 , @entity715 of the basilar artery (BA), multiple hemorrhagic @entity1188 in the midbrain, and pons. Histopathology of the BA revealed the loss of internal elastic lamina and septate hyphae with an acute angle branching on Grocott's @entity1332 silver stain, conforming to the morphology of Aspergillus. CONCLUSION: The possibility of intracranial @entity364 should be strongly considered in any @entity1 receiving intrathecal antibiotics who fails to improve in 1-2 weeks, and frequent CSF culture for fungi should be performed to confirm the diagnosis. Since CSF culture has poor sensitivity in the diagnosis of @entity364 of CNS; empirical institution of antifungal therapy may be considered in this scenario.
