A Perplexing Case of Pituitary Apoplexy Masquerading as Recurrent Meningitis

Area of Science:

• Neurology
• Endocrinology
• Neurosurgery

Background:

• Pituitary apoplexy typically presents with ophthalmoplegia or vision loss.
• Meningeal symptoms are uncommon in pituitary apoplexy.
• Recurrent meningitis can be a rare manifestation of pituitary apoplexy.

Purpose of the Study:

• To report an exceptional case of recurrent pituitary apoplexy presenting as aseptic meningitis.
• To emphasize the importance of considering pituitary apoplexy in patients with recurrent meningitis and pituitary adenoma.
• To highlight the need for early surgical intervention to prevent complications.

Main Methods:

• Case report of a patient with recurrent episodes of meningitis.
• Diagnostic workup included cerebrospinal fluid analysis and neuroimaging (CT and MRI).
• Surgical decompression was performed for definitive diagnosis and treatment.

Main Results:

• The patient presented with meningeal symptoms (headache, stiff neck, nausea) without classical apoplexy signs.
• Cerebrospinal fluid analysis revealed neutrophilic pleocytosis, low glucose, and high protein, consistent with meningitis but with negative cultures.
• MRI confirmed an expansile pituitary gland lesion causing optic chiasm displacement.
• Surgical findings were consistent with pituitary apoplexy.

Conclusions:

• Pituitary apoplexy can present atypically with meningeal symptoms, mimicking meningitis.
• Recurrent aseptic meningitis in patients with pituitary adenoma warrants consideration for pituitary apoplexy.
• Early identification and surgical intervention are crucial for managing pituitary apoplexy and preventing recurrence and morbidity.