A Perplexing Case of Pituitary Apoplexy Masquerading as Meningoencephalitis

Authors

  • Aminur Rahman Assistant Professor, Department of Neurology, Sir Salimullah Medical College, Mitford. Dhaka, Bangladesh
  • Sharna Purna Mondal Resident, Department of Neurology, Sir Salimullah Medical College, Mitford Hospital, Mitford. Dhaka, Bangladesh
  • Muhammed Jamil Ahmed Resident, Department of Neurology, Sir Salimullah Medical College, Mitford Hospital, Mitford. Dhaka, Bangladesh
  • Abul Hasnat Md Russel Resident, Department of Neurology, Sir Salimullah Medical College, Mitford Hospital, Mitford. Dhaka, Bangladesh
  • Ajay Kumar Agarwala Assistant Registrar, Department of Neurology, Sir Salimullah Medical College, Mitford Hospital, Mitford. Dhaka, Bangladesh
  • Furial Quraishi Twinkle Resident, Department of Neurology, Anwer Khan Modern Medical College Hospital, Dhanmondi,. Dhaka, Bangladesh
  • Shahjada Mohammad Dastegir Khan Assistant Professor, Department of Neurology, Sir Salimullah Medical College, , Mitford. Dhaka, Bangladesh
  • Biplob Paul Assistant Professor, Department of Neurology, Sir Salimullah Medical College, , Mitford. Dhaka, Bangladesh
  • Zahed Ali Professor, Department of Neurology, Sir Salimullah Medical College, Mitford. Dhaka, Bangladesh

DOI:

https://doi.org/10.3329/bjm.v33i1.56795

Keywords:

Apoplexy, neurosurgery, panhypopituitarism, pituitary.

Abstract

Pituitary apoplexy (PA) is extremely rare in children and adolescents. It is a life-threatening condition usually results from sudden hemorrhage or infarction induced swelling in a pituitary adenoma. The clinical manifestations of PA include severe headaches, impaired consciousness, fever, visual disturbance, and variable ocular paresis. Therefore, the presence of meningeal irritation may lead to misdiagnosis as a case of meningoencephalitis or spontaneous subarachnoid hemorrhage, and delay in the proper management of the disease. We report a case of 17-year-old pubertal boy who developed sudden severe headache, vomiting, slurring of speech and abnormal behaviour followed by impaired sensorium with fever. The patient who was initially diagnosed with meningoencephalitis (ME) based on clinical presentation and cerebrospinal fluid (CSF) analysis, which was consistent with bacterial meningitis. MRI of brain was performed, confirming a pituitary macroadenoma with hemorrhage and ischemic changes in both basal ganglia and pons. A complete analysis of the pituitary hormones revealed decreased cortisol and thyroid hormone level and hyperprolactinemia and he was subsequently started on placement corticosteroid and L-thyroxine therapy and cabergoline. After 14/ days of antimicrobial therapy with ceftriaxone and ampicillin, the patient improved and was discharged on hormone replacement therapy and surgical advised. Hereby, we report our case with a review of literatures.

Bangladesh J Medicine July 2022; 33(1) : 85-88

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Published

2021-12-06

How to Cite

Rahman, A. ., Mondal, S. P. ., Ahmed, M. J., Md Russel, A. H. ., Agarwala, A. K., Twinkle, F. Q. ., Dastegir Khan, S. M. ., Paul, B. ., & Ali, Z. . (2021). A Perplexing Case of Pituitary Apoplexy Masquerading as Meningoencephalitis. Bangladesh Journal of Medicine, 33(1), 85–88. https://doi.org/10.3329/bjm.v33i1.56795

Issue

Section

Case Reports