Successful treatment of pituitary abscess with intravenous antibiotics: a case report and literature review

Zhu, Hong; Gu, Xin; Jiang, Hong; Shen, Feixia

doi:10.4238/2014.december.12.14

Cited by 15 publications

(9 citation statements)

References 13 publications

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“…Currently, there are no predefined guidelines in the treatment regimen of such a diagnosis. While some authors have documented conservative treatment with intravenous antibiotics alone as an initial empiric treatment, 15 16 17 the majority of cases are diagnosed and treated with surgical exploration. 17 18 19 The rate of disease recurrence after surgery has shown to be less than 10% in several larger studies.…”

Section: Discussionmentioning

confidence: 99%

“…While some authors have documented conservative treatment with intravenous antibiotics alone as an initial empiric treatment, 15 16 17 the majority of cases are diagnosed and treated with surgical exploration. 17 18 19 The rate of disease recurrence after surgery has shown to be less than 10% in several larger studies. 1 2 17 19 However, larger abscesses may require a craniotomy approach for complete evacuation, and these cases have been associated with a higher recurrence rate, estimated at 17.2%.…”

Section: Discussionmentioning

confidence: 99%

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Pituitary Abscess: A Rare Clinical Entity in the Presence of Acute Rhinosinusitis: A Case Report

2018

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A pituitary abscess is an often-overlooked diagnosis in the clinical presentation of a sellar mass. Due to its rare incidence and nonspecific presentation, diagnosis and treatment is often delayed. The authors describe a 56-year-old male patient presenting with acute onset of severe headache, visual field deficit, and radiologic findings of an expansile sellar lesion. The presenting symptoms were unremarkable for the diagnosis of meningitis, cavernous sinus thrombosis, and septicemia. Recent medical history included symptoms of rhinosinusitis on the days preceding his acute presentation. The initial clinical presentation was suggestive of a possible pituitary apoplexy. Intraoperative findings revealed purulent output upon surgical entry of the sella. Histopathology confirmed the diagnosis of a pituitary abscess. Review of the clinical and radiologic data revealed evidence of multiple opacifications within the paranasal sinuses, along with dehiscence overlying the sellar bone, supporting a diagnosis of secondary pituitary abscess. This case, along with a review of the available literature, will serve to expand our knowledge of this rare disease process that is often overlooked. Clinicians should be mindful of this condition, and include a primary versus secondary pituitary abscess in the differential workup on such cases.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Pituitary Abscess: A Rare Clinical Entity in the Presence of Acute Rhinosinusitis: A Case Report

2018

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“…[8][9][10] . Th e most common clinical presentations are diabetes insipidus and the triad of headache, visual disorders and hypopituitarism 2,8,11 . Complete recovery rate was around 60% in patients where adequate treatment was administered, while 30% of patients showed incomplete recovery with visual or endocrine impairment 2,10 .…”

Section: Discussionmentioning

confidence: 99%

Pituitary Abscess With Unusual Clinical Course

Medić-Stojanoska

Kozić

Bjelan

et al. 2016

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SUMMARY -Th e aim is to present unusual clinical course and magnetic resonance imaging (MRI) features of pituitary abscess. A 59-year-old man presented with fever, polyuria, polydipsia and marked weight loss within the last two months. Basic endocrinology tests revealed the presence of anterior pituitary dysfunction, associated with central diabetes insipidus and increased levels of infl ammatory markers. Th e presence of expansile sellar lesion, showing restricted diff usion signal pattern compatible with acute pituitary pyogenic abscess was found on MRI. Regression of pituitary abscess was obvious during the next few weeks of parenteral antibiotic treatment. Adequate substitution treatment with L thyroxine, hydrocortisone, testosterone and desmopressin was achieved. Seventeen months later, clinical deterioration associated with recurrent pituitary abscess was confi rmed on MRI. Abscess regression was obvious again after conservative treatment. However, control MRI study performed three years after initial scanning revealed the presence of pituitary tumor, most consistent with macroadenoma. Surgical intervention was ordered. Histologic evaluation indicated the presence of fi brotic changes, associated with granulation tissue and rare cellular elements, compatible with chronic infl ammation. To the best of our knowledge, there are no studies in the literature describing such a pattern of chronic evolution of pyogenic pituitary abscess with consequent chronic infl ammatory changes with granulation tissue proliferation, mimicking macroadenoma.

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“…This was supported by the finding of abnormal spermiogenesis rather than inflammatory changes in the semen. In human medicine, persistent hypophyseal dysfunction also is a problem after treatment of a pituitary abscess [12] and affected patients may require pituitary hormone replacement therapy. The most likely aetiology of the abscess in the diencephalon was haematogenous spread of bacteria from bronchopneumonia, which preceded the neurological changes.…”

Section: Case Presentationmentioning

confidence: 99%

“…Antibiotics and nonsteroidal anti-inflammatory drugs do not have an appreciable effect on brain abscesses and therefore treatment is usually not recommended. Surgical excision combined with antibiotic treatment is considered the treatment of choice in human patients with pituitary abscess [8–11] but successful treatment with antibiotics alone also has been reported [12]. This case report describes the clinical signs, treatment and postmortem findings in a Holstein–Friesian bull with an abscess in the hypophysis confirmed using CT.…”

Section: Introductionmentioning

confidence: 99%

Computed tomographic findings and treatment of a bull with pituitary gland abscess

et al. 2017

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BackgroundIn cattle, the prognosis of brain abscess is unfavourable and treatment is therefore not recommended. To the knowledge of the authors, there has been no report of successful treatment of a brain abscess in cattle.This report describes the clinical, computed tomographic and postmortem findings in a Holstein–Friesian bull with a hypophyseal abscess.Case reportThe main clinical findings were generalised ataxia, ptyalism, prolapse of the tongue, dropped jaw, dysphagia, head tilt and unilateral ptosis. Cerebrospinal fluid evaluation revealed 2437 leukocytes/µl and severe pleocytosis. CT examination of the head showed a cavitary lesion consistent with an abscess in the hypophysis. Treatment consisted of gentamicin and flunixin meglumine for 3 days and amoxicillin for 40 days. The neurological signs resolved within 8 days of the start of treatment. The bull was slaughtered 11 months later because of infertility, and a postmortem examination was carried out. Histologically, a mild chronic non suppurative meningoencephalitis restricted to the ventral diencephalon was diagnosed. In addition, there was mild to moderate multifocal chronic lymphoplasmacytic hypophysitis with mild multifocal fibrosis.ConclusionsThis case report stresses the significance of CT in confirming the clinical and laboratory diagnosis of central nervous system disorders in cattle and for localising brain lesions. Treatment of the brain abscess resulted, with respect to the central nervous disorder, in a successful outcome and was encouraging considering that most cases have an unfavourable prognosis.

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Successful treatment of pituitary abscess with intravenous antibiotics: a case report and literature review

Cited by 15 publications

References 13 publications

Pituitary Abscess: A Rare Clinical Entity in the Presence of Acute Rhinosinusitis: A Case Report

Pituitary Abscess: A Rare Clinical Entity in the Presence of Acute Rhinosinusitis: A Case Report

Pituitary Abscess With Unusual Clinical Course

Computed tomographic findings and treatment of a bull with pituitary gland abscess

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