Acute aseptic meningitis as the initial presentation of a macroprolactinoma

BMC Research Notes

France Devuyst¹  Bernard Corvilain¹  Nathalie Bakoto³  Danielle Baleriaux²  Marina Boscolo¹ 

[1] Department of Endocrinology, Erasme Hospital, Route de Lennik 808, 1070 Brussels, Belgium;Department of Radiology, Erasme Hospital, Route de Lennik 808, 1070 Brussels, Belgium;Department of Endocrinology, CHU Saint Pierre, Rue Haute 322, 1000 Brussels, Belgium

关键词: Rhinorrhea;    Pituitary apoplexy;    Meningitis;    Macroprolactinoma;   

Others  :  1134988
DOI  :  10.1186/1756-0500-7-9

 received in 2013-01-18, accepted in 2013-12-30,  发布年份 2014

【 摘 要 】

Background

Meningitis is an uncommon complication of an untreated pituitary macroadenoma. Meningitis may occur in patients with macroadenomas who have undergone transsphenoidal surgery and radiotherapy and is usually associated with rhinorrhea. Less commonly, cerebrospinal fluid rhinorrhea has been reported as a complication of treatment of prolactinomas by dopamine agonists. Cerebrospinal fluid rhinorrhea in cases of untreated pituitary macroadenoma is reported only in isolated cases. Acute bacterial meningitis without rhinorrhea in patients with an untreated pituitary macroadenoma is an exceptional finding with only three previously reported cases.

Case presentation

A 31-year-old male was urgently admitted for headache, fever and visual loss. Neuroimaging disclosed an invasive pituitary lesion. Cerebrospinal fluid leakage was not clinically detected. Lumbar puncture showed acute meningitis. Blood tests revealed increased inflammatory markers, a serum prolactin of 9000 ng/ml (2.5-11 ng/ml) and panhypopituitarism. Intravenous antibiotics and hydrocortisone replacement therapy were initiated, leading to a favorable clinical outcome. An endoscopic transsphenoidal debulking procedure was performed, it showed that the sphenoid floor was destroyed and the sinus occluded by a massive tumor.

Conclusions

Meningitis should be ruled out in patients with a pituitary mass who present with headache and increased inflammatory tests, even in the absence of rhinorrhea.

【 授权许可】

   
2014 Boscolo et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

Figure 2.

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