Candida meningitis in three patients who underwent transsphenoidal surgery from a single-institution case series

Candida meningitis is a rare but potentially deadly complication in neurosurgical patients. Most of the published case series include patients who underwent a craniotomy, while just three cases have been reported in patients operated on by transsphenoidal surgery.

We performed an institutional review of patients who underwent transsphenoidal surgery over the last 5 years (2020-2024) at Karolinska University Hospital, Stockholm, Sweden, and searched for patients who were also diagnosed with Candida meningitis as a postoperative complication.

Out of over 400 operated patients, we identified three patients who were affected by postoperative candida meningitis. Two were male, (31 and 70 years old), and one female (37 years old). Pathological analyses revealed craniopharyngioma for the male patients and adenoma for the female patient. Postoperative CSF rhinorrhea occurred in all three patients, and they underwent endonasal endoscopic CSF leak repair surgery and were also treated with lumbar drainage. While none of them was previously immunocompromised, they all developed pituitary failure and were treated with hydrocortisone. The patients were successfully treated with Amphotericin B and Fluconazole.

Although uncommon, Candida meningitis can occur in patients undergoing transsphenoidal surgery and should be suspected in cases of meningitis that do not respond to antibacterial drugs. Previous reports identified extremes of age and previous diagnosis of cancer and immunosuppression as risk factors while the three cases that we report here suggest that Candida meningitis can occur even in previously relatively healthy individuals. Other relevant risk factors for the development of Candida meningitis, such as large central tumors, postoperative CSF leakage, and prolonged cortisone use, should also be considered in the diagnostic process.