LAUSR

Sir, A 46‐year‐old female presented with complaints of progressively worsening headache and visual deterioration of 2 weeks’ duration. On examination, she was found to have bitemporal hemianopia. Magnetic resonance imaging (MRI) showed a sellar‐suprasellar cystic mass extending up to the optic chiasm. The mass was hyperintense on T1 and isointense on T2 sequences with a hypointense rim [Figure 1]. Pituitary adenoma with previous apoplexy was suspected. A transsphenoidal approach to excise the lesion was undertaken, but on opening the capsule yellowish pus came out. This was sent for microbiological examination and a part of the capsule wall was sent for histology. There was no growth on culture and neither could Gram stain demonstrate any organism. However, histopathological examination showed the typical morphology of a sulfur granule with periodic acid– Schiff‐positive short rod‐like, filamentous structures radiating outward. An eosinophilic, amorphous material was seen around the pathogenic organisms – Splendore– Hoeppli phenomenon [Figure 2]. A diagnosis of actinomycotic abscess of the pituitary gland was made. The patient had an uneventful postoperative recovery with improvement of vision and decrease of headache. Initially, she was treated with injection ceftriaxone for 2 weeks, but later this was switched to oral amoxicillin and cloxacillin and this was continued for 4 months. Postoperative MRI done after 1 year showed no residual lesion [Figure 3].