Meningoencephalitis and secondary pituitary abscess in a 16-year-old patient with gigantism

Pituitary adenomas occur in children quite rarely. Furthermore, pituitary abscesses are recognized as particularly rare conditions, posing considerable challenges in both diagnosis and management. We report the case of a 16-year-old patient presenting with bacterial meningoencephalitis of unknown origin, complicated by a superinfected pituitary macroadenoma. The patient initially exhibited clinical signs suggestive of meningitis, and lumbar puncture revealed a macroscopically turbid cerebrospinal fluid. Magnetic resonance imaging identified a frontobasal meningoencephalitis complicated by a suspected apoplectic pituitary adenoma measuring 30.1 mm (volume: 9.0 cm³). Due to the patient's neurological deterioration, urgent surgery was performed. Intraoperatively, the tumor was fibrous and partially necrotic, without evidence of abscess formation. To the best of our knowledge, only 3 cases of meningoencephalitis associated with pituitary adenomas or pituitary abscesses have been reported in the literature. This case provides a detailed account of the patient's clinical presentation, laboratory findings, and radiological results. Based on a comprehensive analysis, hematogenous spread is proposed as the most probable route of infection. We emphasize the importance of evaluating hematogenous spread of infection and tailoring treatment in similar clinical scenarios.