Recurrent sterile meningitis caused by a pituitary abscess

Ford, Jennifer; Torres, Luíz Fernando Bleggi; Cox, Terry A.; Hayward, Richard

doi:10.1136/pgmj.62.732.929

Cited by 22 publications

(5 citation statements)

References 6 publications

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“…Our patient had symptoms of pituitary insufficiency before developing meningitis; therefore, it was assumed that the central nervous system infection occurred due to spread from the pituitary lesion. A possible explanation of this is the leakage of pus into the subarachnoid space ( 6 , 9 ). However, the converse possibility has also been described, that is the direct spread of infection to the pituitary from a nearby focus, such as the sphenoid sinus or the cavernous sinus ( 10 , 11 , 12 ).…”

Section: Discussionmentioning

confidence: 99%

Pituitary abscess: a case report and review of the literature

Karagiannis¹,

Dimitropoulou²,

Παπαθεοδώρου³

et al. 2016

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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SummaryPituitary abscess is a rare life-threating entity that is usually misdiagnosed as a pituitary tumor with a definite diagnosis only made postoperatively. Over the last several decades, advances in healthcare have led to a significant decrease in morbidity and mortality due to pituitary abscess. We report a case of a 34-year-old woman who was admitted to our department for investigation of a pituitary mass and with symptoms of pituitary dysfunction, headaches and impaired vision. During her admission, she developed meningitis-like symptoms and was treated with antibiotics. She eventually underwent transsphenoidal surgery for excision of the pituitary mass. A significant amount of pus was evident intraoperatively; however, no pathogen was isolated. Six months later, the patient was well and had full recovery of the anterior pituitary function. Her menses returned, and she was only on treatment with desmopressin for diabetes insipidus that developed postoperatively.Learning pointsPituitary abscess is a rare disease and the reported clinical features vary mimicking other pituitary lesions.The diagnosis of pituitary abscess is often very difficult to make and rarely included in the differential.The histological findings of acute inflammatory infiltration confirm the diagnosis of pituitary abscess.Medical and surgical treatment is usually recommended upon diagnosis of a pituitary abscess.

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Section: Discussionmentioning

confidence: 99%

Pituitary abscess: a case report and review of the literature

Karagiannis¹,

Dimitropoulou²,

Παπαθεοδώρου³

et al. 2016

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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show abstract

“…[6,18] Earlier studies suggested that leakage of irritant contents from the abscess into the CSF space led to recurrent episodes of meningitis. [19,20] However, our patient suffered recurrent meningitis with dormant imaging manifestations early after the 1st TS. Therefore, based on our patient's characteristics, we attribute the pathogenesis of secondary PA to three factors: bacterial colonization of the sphenoid sinus, reduced local immunity in the sellar region, and reduced systemic immunity.…”

Section: Discussionmentioning

confidence: 83%

Secondary pituitary abscess following transsphenoidal surgery with recurrent meningitis

Li¹,

Yang

Bao

et al. 2018

Medicine

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Rationale:The transsphenoidal surgical (TS) approach to sellar masses is the preferred surgical route in most cases. Secondary pituitary abscess (PA) following TS is an extremely rare but serious postoperative complication with potentially high disability and mortality.Patient concerns:We describe an uncommon case of secondary PA in a 42-year-old woman, who underwent uncomplicated transsphenoidal procedures without cerebrospinal fluid leak, to treat primary Rathke cleft cyst. Without obvious cause, the patient suffered recurrent meningitis with complaints of headache, hyperpyrexia, and chills from 1 month after the operation.Diagnosis:There were no significant imaging findings until a new rim-enhancement lesion was seen in the sellar region on magnetic resonance imaging during the 6th episode of meningitis 11 months after the initial surgery. A diagnosis of secondary PA was considered;Interventions:Therefore, she underwent a 2nd TS with pus evacuation and antibiotic treatment.Outcomes:She improved remarkably and had no recurrence of symptoms during the 9-month follow-up.Lessons:Our aim was to present this rare case and discuss the most likely etiologies and preventive measures for this condition. In patients with recurrent meningitis but dormant imaging manifestations after TS, the possibility of secondary PA should considered. Adequate surgical drainage with microbiology-guided antibiotic therapy is the 1st choice for treatment.

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“…It is uncommon for pituitary adenomas to present with diabetes insipidus ( 2 ). However, other suprasellar masses, such as pituitary abscesses, often present with diabetes insipidus ( 6 ).…”

Section: Discussionmentioning

confidence: 99%

A case of pituitary abscess presenting without a source of infection or prior pituitary pathology

Adams

Kern

2016

Endocrinology, Diabetes &Amp; Metabolism Case Reports

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SummaryPituitary abscess is a relatively uncommon cause of pituitary hormone deficiencies and/or a suprasellar mass. Risk factors for pituitary abscess include prior surgery, irradiation and/or pathology of the suprasellar region as well as underlying infections. We present the case of a 22-year-old female presenting with a spontaneous pituitary abscess in the absence of risk factors described previously. Her initial presentation included headache, bitemporal hemianopia, polyuria, polydipsia and amenorrhoea. Magnetic resonance imaging (MRI) of her pituitary showed a suprasellar mass. As the patient did not have any risk factors for pituitary abscess or symptoms of infection, the diagnosis was not suspected preoperatively. She underwent transsphenoidal resection and purulent material was seen intraoperatively. Culture of the surgical specimen showed two species of alpha hemolytic Streptococcus, Staphylococcus capitis and Prevotella melaninogenica. Urine and blood cultures, dental radiographs and transthoracic echocardiogram failed to show any source of infection that could have caused the pituitary abscess. The patient was treated with 6weeks of oral metronidazole and intravenous vancomycin. After 6weeks of transsphenoidal resection and just after completion of antibiotic therapy, her headache and bitemporal hemianopsia resolved. However, nocturia and polydipsia from central diabetes insipidus and amenorrhoea from hypogonadotrophic hypogonadism persisted.Learning pointsPituitary abscesses typically develop in patients who have other sources of infection or disruption of the normal suprasellar anatomy by either surgery, irradiation or pre-existing pathology; however, they can develop in the absence of known risk factors.Patients with pituitary abscesses typically complain of headache, visual changes and symptoms of pituitary hormone deficiencies.As other pituitary neoplasms present with similar clinical findings, the diagnosis of pituitary abscess is often not suspected until transsphenoidal resection is performed.Prompt surgical and medical treatment of pituitary abscess is necessary, which typically results in improvement in headache and visual changes; however, pituitary hormone deficiencies are typically often permanent.

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Recurrent sterile meningitis caused by a pituitary abscess

Cited by 22 publications

References 6 publications

Pituitary abscess: a case report and review of the literature

Pituitary abscess: a case report and review of the literature

Secondary pituitary abscess following transsphenoidal surgery with recurrent meningitis

A case of pituitary abscess presenting without a source of infection or prior pituitary pathology

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