Recurrent fever of unknown origin, coma, and meningismus due to a leaking craniopharyngioma.
A cyclic leaking craniopharyngioma was found to be the source of recurrent fevers, meningismus, and coma. A sterile persistent neutrophilic pleocytosis with normal glucose and protein was the only clue in an extensive workup. Three head computed tomographic scans, including double contrast with 5-mm cuts, failed to locate the large suprasellar cyst outlined finally by head computed tomographic scan with metrizamide. A handful of case reports exist about leaking central nervous system cysts, but their presentation tended to be different: increased protein, lymphocytosis, and positive cranial imaging. It is believed this is a unique case that adds to the spectrum of chronic neutrophilic meningitis.
Krueger
D W
DW
Department of Medicine, University of Washington, Seattle 98155.
Larson
E B
EB
D000368:Aged; D003128:Coma / Q000209:etiology*; D003397:Craniopharyngioma / Q000150:complications* / Q000000981:diagnostic imaging; D005335:Fever of Unknown Origin / Q000209:etiology*; D006801:Humans; D008297:Male; D008580:Meningism / Q000209:etiology*; D010911:Pituitary Neoplasms / Q000150:complications* / Q000000981:diagnostic imaging; D014057:Tomography, X-Ray Computed