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Secondary pituitary abscess following transsphenoidal surgery with recurrent meningitis
- Source :
- Medicine
- Publication Year :
- 2018
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2018.
-
Abstract
- 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.
- Subjects :
- Adult
medicine.medical_specialty
Sphenoid Sinus
Pituitary Diseases
medicine.medical_treatment
Pituitary Abscess
Brain Abscess
Rathke cleft cyst
030209 endocrinology & metabolism
Meningitis, Bacterial
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Recurrent meningitis
Humans
secondary pituitary abscess
Medicine
Pituitary Neoplasms
Clinical Case Report
Central Nervous System Cysts
Transsphenoidal surgery
recurrent meningitis
Cerebrospinal fluid leak
business.industry
transsphenoidal surgery
Postoperative complication
General Medicine
medicine.disease
Surgery
Pituitary Gland
Etiology
Female
Chills
medicine.symptom
business
dormant imaging manifestation
Meningitis
030217 neurology & neurosurgery
Research Article
Subjects
Details
- ISSN :
- 15365964 and 00257974
- Volume :
- 97
- Database :
- OpenAIRE
- Journal :
- Medicine
- Accession number :
- edsair.doi.dedup.....fe748a0ece8e50a9ae829f2373738547