Cerebrospinal meningitis in a 30­‍-year­‍-old patient as first manifestation of pituitary macroadenoma

Elżbieta Andrysiak­‍-Mamos, Ewa Żochowska, Agnieszka Kaźmierczyk­‍-Puchalska, Leszek Sagan, Elżbieta Sowińska­‍-Przepiera, Małgorzata Zając­‍-Marczewska, Ireneusz Kojder, Anhelli Syrenicz


Introduction: The most common clinical and neurological signs and symptoms of pituitary macroadenomas include headache, vision impairment and cranial nerve palsy.

Case report: The patient presented in this article was admitted to the Intensive Care Unit at regional hospital; at admission, the patient was unconscious, he had convulsions and spasms, and a 3­‍-day history of headache and body temperature up to 41.5°C. The patient with suspected neuroinfection was transferred to the Department of Infectious Diseases of the Pomeranian Medical University in Szczecin (PMU), where cerebrospinal meningitis of bacterial etiology was established based on cerebrospinal fluid investigations and the presence of pituitary abscess was suggested based on magnetic resonance imaging (MRI). Magnetic resonance imaging findings included an extensive pathological lesion with the diameter of 27 × 28 × 38 mm located in the sellar­‍-suprasellar region, with intensive peripheral contrast enhancement. The lesion protrudes into the sphenoid sinus through the lowered bottom of sella turcica and the fluid content has also been visualized in the sphenoid sinus. After 10­‍-day antibiotic therapy, the patient was transferred to neurosurgery ward for surgical treatment. The pathological lesion was partially evacuated during right frontotemporal craniotomy. The patient’s general condition after the surgery was moderately severe; the patient was conscious, able to follow simple commands, presenting hemiparesis of the left side of the body, particularly affecting left lower limb and with speech disturbances. The signs of hypopituitarism affecting all hormonal axes were also observed and the patient was transferred to the Department of Endocrinology of the PMU for further treatment. Follow­‍-up MRI scan continued to show the presence of pathological mass in the sellar­‍-suprasellar region, which penetrated into the sphenoid sinus through damaged sellar bottom. After correction of reduced hormone levels and several weeks of antibiotic therapy, the patient was transferred to the Department of Neurosurgery of the PMU for further surgical treatment. Transsphenoidal resection of the sellar­‍-suprasellar tumor and sphenoid sinus reconstruction were performed. Histopathology report confirmed the diagnosis of pituitary adenoma. The patient in relatively good condition, with partial hemiparesis on the left side of the body, able to stand with support, not able to walk, with speech disturbances and able to follow commands was transferred to the rehabilitation center. One year later, follow­‍-up MRI scan showed deepened sella turcica, filled with a mass corresponding to postoperative material. No evidence of disease progression has been found.

Conclusion: Neuroinfection may be the first manifestation of pituitary macroadenoma.


pituitary tumor; macroadenoma; meningitis; hypopituitarism

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DOI: https://doi.org/10.21164/pomjlifesci.425

Copyright (c) 2018 Elżbieta Andrysiak­‍-Mamos, Ewa Żochowska, Agnieszka Kaźmierczyk­‍-Puchalska, Leszek Sagan, Elżbieta Sowińska­‍-Przepiera, Małgorzata Zając­‍-Marczewska, Ireneusz Kojder, Anhelli Syrenicz

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