Erosion of the sella turcica and pituitary expansion secondary to polymicrobial brain abscesses: a case report

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Brendan Ryu1, Deepak Khatri1, Avraham Zlochower2

  • 1Department of Neurosurgery, Lenox Hill Hospital, Donald and Barbara Zucker School of Medicine at Hofstra/Northwell, New York, NY, USA.

Access Microbiology
|November 24, 2021
PubMed
Abstract

Insights

Polymicrobial brain abscesses can cause rare complications like pituitary enlargement and SIADH. Targeted antibiotics successfully resolved these issues, highlighting the importance of close follow-up for potential CSF leaks.

Area of Science:

  • Neurology
  • Endocrinology
  • Infectious Diseases

Background:

  • Polymicrobial brain abscesses present diverse complications requiring prompt diagnosis and treatment.
  • Skull base osteomyelitis with sellar floor erosion and pituitary involvement leading to SIADH are previously unreported complications of brain abscesses.

Observation:

  • A case of a 38-year-old immunocompetent male with a polymicrobial brain abscess presenting with altered mental status and hemiparesis.

Findings:

  • Surgical evacuation of the abscess was performed, followed by management of severe hyponatremia secondary to SIADH.
  • Radiological imaging revealed pituitary enlargement with herniation through an eroded sella turcica.
  • Antibiotic therapy, guided by susceptibility testing, led to complete resolution of pituitary enlargement.

Implications:

  • Conservative management with targeted antibiotics can effectively resolve pituitary enlargement secondary to brain abscess.
  • Close clinical monitoring is crucial for detecting CSF leaks, especially with osteomyelitis-induced sellar floor erosion.
Keywords:
SIADHbrain abscessosteomyelitispituitary glandsella turcica

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