BMC Neurology (Jan 2023)

A case of pituitary gland abscess associated with granulomatous hypophysitis

  • Mohammad Mahdi Rabiei,
  • Kaveh Ebrahimzadeh,
  • Zahra Davoudi,
  • Farahnaz Bidari Zerehpoosh,
  • Farid Javandoust Gharehbagh,
  • Roghayeh Sedaghati,
  • Legha Lotfollahi,
  • Fatemeh Kalhor,
  • Ilad Alavi Darazam

DOI
https://doi.org/10.1186/s12883-023-03060-6
Journal volume & issue
Vol. 23, no. 1
pp. 1 – 6

Abstract

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Abstract Background Granulomatous hypophysitis is a rare disease that presents with chronic inflammation of the pituitary gland. In this study, we reported a case of granulomatous hypophysitis associated with a pituitary abscess. Case presentation A 39-year-old woman presented with a 2-year history of infertility. For the past six months, she has suffered from amenorrhea, decreased libido, headaches, and vertigo. She was referred to our hospital with a suspected diagnosis of nonfunctioning pituitary adenoma based on her presentation and brain MRI findings. She underwent trans-sphenoidal surgery (TSS). Direct observation during surgery revealed drainage of malodor pus and pituitary gland abscess. The histopathological evaluation also showed granulomatous hypophysitis and neutrophilic microabscess formation. The patient was initially treated with high doses of ceftriaxone (2 g twice daily) and metronidazole (500 mg (mg) four times per day). Also, the patient received cortisol replacement therapy after the operation. After obtaining the antibiogram and culture results, the treatment regimen was continued for 4 weeks postoperatively, followed by amoxicillin-clavulanate (500/125 mg three times daily) for a total duration of 12 weeks. Conclusion The patient recovered uneventfully and the postoperative MRI was normal without any remnant lesions.

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