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07:43

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Pituitary adenoma apoplexy with initial presentation mimicking bacterial meningoencephalitis: a case report

Wen-Yi Huang1, Yu-Yi Chien, Chia-Lun Wu

  • 1Department of Neurology, Keelung Chang Gung Memorial Hospital, Keelung, Taiwan 204, Republic of China. wenyihuang2003@yahoo.com.tw

The American Journal of Emergency Medicine
|June 27, 2009
PubMed

Insights

Pituitary apoplexy, a rare condition, can mimic infectious meningoencephalitis. Prompt diagnosis and treatment, including corticosteroids and surgery, are crucial for recovery.

Area of Science:

  • Endocrinology
  • Neurology
  • Neurosurgery

Background:

  • Pituitary apoplexy is a rare, life-threatening endocrine emergency.
  • Clinical signs often include severe headache, altered consciousness, fever, visual deficits, and ocular paresis.
  • Meningeal irritation signs are uncommon but can lead to misdiagnosis.

Observation:

  • A 57-year-old male presented with symptoms mimicking infectious meningoencephalitis: severe headache, fever, neck stiffness, consciousness disturbance, and left ocular paresis.
  • Cerebrospinal fluid analysis revealed neutrophilic pleocytosis, leukocytosis, and elevated C-reactive protein, initially suggesting bacterial meningoencephalitis.
  • Empiric antibiotic treatment proved ineffective.

Findings:

  • Further investigations confirmed the diagnosis of pituitary adenoma with apoplexy.
  • The patient's presentation closely mimicked infectious meningoencephalitis due to meningeal signs and CSF findings.
  • This case highlights a rare initial presentation of pituitary apoplexy.

Implications:

  • Early recognition of pituitary apoplexy is vital to avoid delayed or incorrect treatment.
  • Prompt corticosteroid administration and surgical decompression are critical for favorable outcomes.
  • This case underscores the importance of considering pituitary apoplexy in the differential diagnosis of acute neurological syndromes with fever and meningeal signs.

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