Erosion of the sella turcica and pituitary expansion secondary to polymicrobial brain abscesses: a case report

Abstract

Introduction. Brain abscesses can lead to a diverse array of complications, especially when they are polymicrobial in nature. Multiple underlying pathogens may present with a unique set of clinical symptoms which require an early identification and treatment. Skull base osteomyelitis with sellar floor erosion and pituitary involvement with SIADH are such rare complications of brain abscesses which have never been reported previously in the literature. Case Presentation. We report the case of an immunocompetent 38-year-old male with altered mental sensorium and left hemiparesis due to polymicrobial brain abscess which required surgical evacuation. The post-operative recovery was complicated by severe hyponatremia secondary to SIADH which was treated uneventfully. Radiological imaging demonstrated pituitary enlargement with herniation through an eroded sella turcica without active CSF leak. Patient responded well to the antibiotic therapy based on microbiological susceptibility testing with a complete resolution of the pituitary enlargement on radiological follow-up. Conclusion. Conservative treatment with targeted antibiotics can lead to the resolution of pituitary enlargement secondary to a brain abscess. However, a close clinical follow-up is required to look for a CSF leak considering the sellar floor erosion due to osteomyelitis.

Erythrasma: A Superficial Cutaneous Bacterial Infection Overlooked in Clinical Practice

“…19 In hosts who are immunocompromised, C. minutissimum can cause invasive infections such as catheter-related bloodstream infections, prosthetic device and graft infections, peritonitis (in patients receiving peritoneal dialysis), abscesses, postoperative wound infections, osteomyelitis, endocarditis, embolic ocular infections, meningitis, brain abscess, and pyelonephritis. [20][21][22][23][24][25][26][27][28][29][30] It is plausible that erythrasma increases the risk for invasive infection in such individuals, although evidence for this is lacking.…”