title: Post-operative Streptococcus pneumoniae meningoencephalitis complicating surgery for acromegaly in an identical twin.
abstract: This case report provides provocative and useful data regarding two aspects of acromegaly and its management. The patient, who is one of a pair of identical twins, has no known hereditary, genetic or otherwise potentially etiologic factors as compared to her unaffected sister. Secondly, transsphenoidal surgery, which was ultimately successful, was complicated by pneumococcal meningitis, an unusual event with only four previously reported patients, three of whom ended in death or major neurologic deficits. In this case, a 57-year-old woman gradually developed classical signs and symptoms of acromegaly while her identical twin sister remained normal with no evidence of endocrine disease. Endoscopic transsphenoidal surgery was complicated by the development of meningitis 25 days after surgery. This was controlled following a difficult hospital course. Streptococcus pneumoniae meningoencephalitis is a rare but life-threatening complication of transsphenoidal surgery. A high index of suspicion for incipient meningitis should be maintained when patients present with severe headache and increased intracranial pressure, even if they initially lack the typical symptoms and signs. Immediate and aggressive treatment is necessary to avoid significant neurologic deficit.
authors: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, Boston MA 02115, USA.
authors: David J
authors: DJ
authors: Cote
authors: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, Boston MA 02115, USA.
authors: Sherry L
authors: SL
authors: Iuliano
authors: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, Boston MA 02115, USA.
authors: Timothy R
authors: TR
authors: Smith
authors: Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, 15 Francis Street, Boston MA 02115, USA. Electronic address: elaws@partners.org.
authors: Edward R
authors: ER
authors: Laws
mesh_terms: D000172:Acromegaly / Q000601:surgery*; D005260:Female; D006801:Humans; D008586:Meningitis, Pneumococcal / Q000209:etiology*; D008590:Meningoencephalitis / Q000209:etiology*; D008875:Middle Aged; D019635:Neurosurgical Procedures / Q000009:adverse effects*; D010911:Pituitary Neoplasms / Q000601:surgery; D011183:Postoperative Complications / Q000382:microbiology*; D013296:Streptococcus pneumoniae; D014430:Twins, Monozygotic
keywords: Acromegaly; Meningitis; Pituitary adenoma; Transsphenoidal surgery