Pituitary tumor apoplexy presenting as infective meningoencephalitis

Abstract

Background: Pituitary apoplexy is a rare but life-threatening disorder usually results from sudden hemorrhage or infarction induced swelling in a pituitary adenoma. Clinical presentation of this condition includes severe headaches, impaired consciousness, fever, visual disturbance, and variable ocular paresis. Therefore, the presence of meningeal irritation may lead to misdiagnosis as a case of meningoencephalitis or spontaneous subarachnoid hemorrhage, and delay in the proper management of the disease. Objective: To demonstrate necrosis of a pituitary adenoma was clinically indistinguishable from infectious meningitis. Case report: We report a case of 25-year-old man who developed progressive drowsiness with headache and fever. CT scan of the Brain and also MRI were performed, confirming a pituitary macroadenoma with hemorrhage and analysis of the cerebrospinal fluid (CSF) was consistent with bacterial meningitis. Serum investigations revealed panhypopituitarism and he was subsequently started on placement corticosteroid, L-thyroxine therapy and cabergoline After 14 days of antimicrobial therapy with ceftriaxone and ampicillin, the patient improved with 1 year follow up and new Brain MRI clearly demonstrating tumoral reduction. Conclusion: We highlighted how pituitary apoplexy may mimic the clinical findings of an infectious meningoencephalitis, learning points on how clinical assessment can aid earlier diagnosis and the importance of considering this differential diagnosis, particularly with the associated morbidity and mortality. Keywords: Pituitary apoplexy, Meningoencephalitis, Macroadenoma