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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
PubMed

Insights

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.

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.

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