HIV Presenting as Inflammatory Pseudotumor of the Skull Base: Case Report and Review of the Literature

A 52-year-old woman presented with frontal headaches, panhypopituitarism, and right cranial nerve VI palsy. MRI of the brain with gadolinium revealed a destructive process involving the clivus and bilateral petrous apices, and extending into bilateral cavernous sinuses with encasement and narrowing of the bilateral cavernous carotids. There was soft tissue enhancement of the pre-pontine cistern with extension into the sella and enlargement of the pituitary gland. CT scan showed bony erosion of the skull base. Transnasal transsphenoidal biopsy showed friable bone in the rostrum of the sphenoid sinus. Pathology revealed connective and adipose tissue with acute and chronic inflammation and granulation tissue. Cultures were negative. Patient was also diagnosed with HIV during her hospital stay. She responded well clinically and radiographically to steroids. A 3-month follow-up MRI revealed persistent erosive lesion in the base of the occiput and clivus with decreased extension into the cavernous sinus, sella, and suprasellar region. Inflammatory pseudotumor of the anterior skull base is a rare entity that can be diagnostically challenging. Few cases are present in the literature and are idiopathic or caused by inflammatory or autoimmune diseases. We present the first case of inflammatory pseudotumor of the anterior skull base associated with HIV with a review of the literature and stress the importance of endoscopic transnasal biopsy for the diagnosis and management of this disease