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A Pituitary Abscess Caused by Morganella morganii: A Case Report
Fayez M Alelyani1,2, Yahya Ahmad Almutawif3, Hamza Mohammad Ali3
1Department of Neurosurgery, King Fahad Hospital, Madinah, Saudi Arabia.
Abstract:
BACKGROUND Pituitary abscess (PA) is a rare pituitary lesion accounting for less than 1% of all pituitary diseases and is associated with high mortality rates. The non-specific clinical symptoms and radiological features preclude accurate diagnosis of the disease. Hence, surgical intervention is still considered the criterion standard method for PA diagnosis. Most PAs occur as a primary disease or due to complications such as surgery, sepsis, and adjacent inflamed lesions. CASE REPORT A 53-year-old man presented to the Emergency Department with a headache associated with nausea, vomiting, and constipation. The patient had no visual disturbances, polyuria, polydipsia, nocturia, or abnormal discharges. Computed tomography (CT) and magnetic resonance imaging (MRI) showed a large suprasellar mass. The patient underwent left-side trans-nasal transsphenoidal microscopic surgery for mass removal. An abscess with discharge was noticed and sent for microbiological evaluation, revealing an infection with a commensal enteric bacterium that rarely causes nosocomial infection, known as Morganella morganii. The patient was discharged after completing the intravenous antibiotic course and was given oral antibiotics. CONCLUSIONS Pituitary abscess is a rare pituitary lesion. However, taking the history of recent meningitis, sinusitis, and/or surgery may help to reach an early diagnosis, prompt surgical intervention, and vital therapeutic steps to reduce mortality rates and improve patient's outcomes. PA should always be considered when patients demonstrate signs of pituitary dysfunction associated with signs of infection. Furthermore, antibiotics should be administered immediately once the PA case is confirmed and should last for at least 6 weeks postoperatively.
Insights
Pituitary abscess (PA) is a rare but serious condition. Early diagnosis and surgical intervention for PA are crucial for reducing mortality and improving patient outcomes.
Area of Science:
- Endocrinology
- Neurosurgery
- Infectious Diseases
Background:
- Pituitary abscess (PA) is an uncommon pituitary lesion, representing less than 1% of all pituitary diseases, with significant associated mortality.
- Non-specific clinical and radiological features often delay diagnosis, making surgical intervention the gold standard for confirmation.
- PAs can arise primarily or secondary to surgical complications, sepsis, or adjacent infections.
Observation:
- A 53-year-old male presented with headache, nausea, vomiting, and constipation, without visual disturbances or other typical pituitary dysfunction symptoms.
- Imaging revealed a large suprasellar mass, leading to trans-nasal transsphenoidal surgery.
- Intraoperative findings included an abscess, later identified by microbiological evaluation as Morganella morganii, a rare cause of nosocomial infection.
Findings:
- Morganella morganii, a rare enteric bacterium, was identified as the causative agent of the pituitary abscess.
- Successful surgical drainage and a course of intravenous and oral antibiotics led to patient recovery.
- The patient was discharged after completing antibiotic therapy.
Implications:
- Considering PA in patients with pituitary dysfunction and signs of infection, especially with a history of meningitis, sinusitis, or surgery, can aid early diagnosis.
- Prompt surgical intervention and a minimum of 6 weeks of postoperative antibiotics are vital for reducing PA mortality and improving outcomes.
- This case highlights the importance of microbiological evaluation in diagnosing rare causes of pituitary abscesses.
