title: Cerebral vasculitis complicating postoperative meningitis: the role of steroids revisited.
abstract: Meningitis due to Streptococcus pneumoniae is a rare complication of trans-sphenoidal surgery. We present the case of a patient who developed pneumococcal meningitis with associated bacteraemia after elective endoscopic trans-sphenoidal resection of a pituitary macro-adenoma. After initial treatment with ceftriaxone and dexamethasone, the patient made a good recovery and dexamethasone was discontinued. Two days later the patient's condition deteriorated rapidly, presenting focal and diffuse neurological deficits. Cerebral MRI revealed widespread punctate ischaemic-type lesions affecting both anterior and posterior vascular territories bilaterally and involving features consistent with cerebral vasculitis. Antibiotic treatment was broadened to include meropenem and dexamethasone was restarted, but the patient remained in a comatose state and died 14 days later. Steroid treatment may play a dual role in this poorly characterised infectious complication of trans-sphenoidal pituitary surgery. This possibility is discussed and the options for prophylaxis are reviewed.
authors.affiliation: Service of Infectious Diseases, Clinique Hospitalier Universitaire Vaudois, Lausanne, Switzerland. katharine.darling@chuv.ch
authors.forename: Katharine E A
authors.initials: KE
authors.lastname: Darling
authors.forename: Julien
authors.initials: J
authors.lastname: Niederhauser
authors.forename: David
authors.initials: D
authors.lastname: Bervini
authors.forename: Stefano
authors.initials: S
authors.lastname: Giulieri
authors.forename: Roy T
authors.initials: RT
authors.lastname: Daniel
authors.forename: Jacques
authors.initials: J
authors.lastname: Bille
authors.forename: Veronique
authors.initials: V
authors.lastname: Erard
mesh_terms: D000236:Adenoma / Q000601:surgery; D000305:Adrenal Cortex Hormones / Q000009:adverse effects*; D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017558:Elective Surgical Procedures / Q000009:adverse effects; D005260:Female; D006801:Humans; D016920:Meningitis, Bacterial / Q000139:chemically induced* / Q000150:complications* / Q000188:drug therapy; D010911:Pituitary Neoplasms / Q000601:surgery; D011183:Postoperative Complications / Q000139:chemically induced*; D013296:Streptococcus pneumoniae; D020293:Vasculitis, Central Nervous System / Q000150:complications*
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents