Recurrent Aseptic Meningitis Revealing Primitive Pituitary Abscess

We report a case of primitive pituitary abscess (PA) in a teenage girl who was admitted on three occasions for acute meningitis. A lumbar puncture revealed aseptic meningitis and the brain MRI showed a well-defined intrasellar space-occupying lesion with suprasellar extension suggestive of macroadenoma. The patient remained free of symptoms between episodes of meningitis however she developed a diabetes insipidus. The diagnosis of PA was established preoperatively but no microorganisms were isolated. Postoperatively she developed pan-hypopituitarism. Her growth velocity remained normal. At the age of 17 years, she was started on somatotropin in view of low insulin-like growth factor-1 (IGF1) level. This case illustrates an insidious presentation of PA in a child without apparent risk factors and complicated with hypopituitarism. Early diagnosis and treatment are crucial to prevent life-threatening complications and irreversible pituitary dysfunction.