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Recurrent Bacterial Meningitis Perpetuated by an Infected Rathke's Cleft Cyst.

P Berlit¹, K Keyvani², A Herring²

¹Neurologische Klinik, Alfried Krupp Krankenhaus, Essen.

Fortschritte Der Neurologie-Psychiatrie

|November 24, 2015

Summary

Bacterial meningitis developed in a woman due to an infected Rathke's cleft cyst (RCC) after steroid withdrawal. This case highlights the risk of infection in pituitary cysts, even after prior diagnosis.

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Area of Science:

Neuroscience
Infectious Diseases
Endocrinology

Background:

Rathke's cleft cysts (RCCs) are common sellar lesions, typically benign and asymptomatic.
Pituitary cysts can rarely become infected, leading to serious complications.
Steroid therapy can modulate the immune system, potentially increasing susceptibility to infections.

Observation:

A 52-year-old woman presented with symptoms of meningitis (headache, nuchal rigidity, fever, nausea, vomiting) after discontinuing prednisolone treatment for suspected myositis.
Cerebrospinal fluid (CSF) analysis indicated bacterial meningitis.
An MRI revealed a non-enhancing pituitary cystic lesion, previously identified as a suspected RCC.

Findings:

The patient underwent transsphenoidal surgery for suspected RCC empyema.
Neuropathological examination confirmed purulent material with gram-positive cocci within the Rathke's cleft cyst.
The findings established a diagnosis of infected RCC presenting as bacterial meningitis.

Implications:

This case underscores the importance of considering pituitary cyst infection in patients with meningitis, particularly those with a history of pituitary lesions.
Steroid withdrawal may unmask or precipitate infections in pre-existing cystic lesions.
Early diagnosis and surgical management of infected RCC are crucial for favorable outcomes.