Infection of a Rathke cleft cyst: a rare cause of pituitary abscess.
BACKGROUND
Only 20 cases of abscess formation within a Rathke cleft cyst have been reported.


METHODS
Case report and review of the English-language literature.


RESULTS
A 64-year-old female was admitted with a 12-mo history of headache and decreased visual acuity and had bilateral papilledema and bitemporal hemianopsia with impairment of visual acuity. Magnetic resonance imaging demonstrated a sellar and suprasellar mass measuring 2×2×2 cm. The lesion was removed using a transsphenoidal approach. The abscess was drained, and gram stain revealed polymorphonuclear cells and gram-positive cocci. The postoperative course was uneventful. Ceftriaxone and metronidazole were continued for 6 wks. The patient also received hydrocortisone and continued thyroid hormone replacement. During a 6-mo follow up, the patient's headaches disappeared, and the bitemporal hemianopsia and impaired visual acuity abated.


CONCLUSIONS
Predisposing factors for pituitary abscesses in primary lesions include immunosuppression and pituitary irradiation, surgery, or infarction. Approximately one-third of pituitary abscesses arise within other lesions. The clinical manifestations are non-specific. Magnetic resonance imaging shows a cystic lesion with central low intensity and rim enhancement after administration of contrast. When a pituitary abscess is diagnosed, surgical procedures should be performed promptly via a transsphenoidal (preferably) or transcranial approach.
Department of Neurosurgery, Mohammed V Military Teaching Hospital, Mohammed V-Souissi University , Rabat, Morocco .
Okacha
O
Naama
Miloudi
M
Gazzaz
Omar
O
Boulahroud
Brahim
B
Elmoustarchid
D000890:Anti-Infective Agents / Q000627:therapeutic use; D001921:Brain / Q000000981:diagnostic imaging; D001922:Brain Abscess / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery; D002443:Ceftriaxone / Q000627:therapeutic use; D020863:Central Nervous System Cysts / Q000150:complications*; D003646:Debridement; D004322:Drainage; D005260:Female; D006801:Humans; D008279:Magnetic Resonance Imaging; D008795:Metronidazole / Q000627:therapeutic use; D008875:Middle Aged; D010900:Pituitary Diseases / Q000175:diagnosis* / Q000473:pathology* / Q000601:surgery; D011859:Radiography
D000890:Anti-Infective Agents; D008795:Metronidazole; D002443:Ceftriaxone