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Volume 3, Issue 10

Erosion of the sella turcica and pituitary expansion secondary to polymicrobial brain abscesses: a case report Open Access

Abstract

Brain abscesses can lead to a diverse array of complications, especially when they are polymicrobial in nature. Multiple underlying pathogens may present with a unique set of clinical symptoms which require an early identification and treatment. Skull base osteomyelitis with sellar floor erosion and pituitary involvement with SIADH are such rare complications of brain abscesses which have never been reported previously in the literature.

We report the case of an immunocompetent 38-year-old male with altered mental sensorium and left hemiparesis due to polymicrobial brain abscess which required surgical evacuation. The post-operative recovery was complicated by severe hyponatremia secondary to SIADH which was treated uneventfully. Radiological imaging demonstrated pituitary enlargement with herniation through an eroded sella turcica without active CSF leak. Patient responded well to the antibiotic therapy based on microbiological susceptibility testing with a complete resolution of the pituitary enlargement on radiological follow-up.

Conservative treatment with targeted antibiotics can lead to the resolution of pituitary enlargement secondary to a brain abscess. However, a close clinical follow-up is required to look for a CSF leak considering the sellar floor erosion due to osteomyelitis.

  • Received:
  • Accepted:
  • Published Online:
Keyword(s): brain abscess , osteomyelitis , pituitary gland , sella turcica and SIADH
© 2021 The Authors
  • This is an open-access article distributed under the terms of the Creative Commons Attribution License. The Microbiology Society waived the open access fees for this article.
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2021-10-20
2024-05-09
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References

  1. Muzumdar D, Jhawar S, Goel A. Brain abscess: An overview. Int J Surg 2011; 9:136–144 [View Article] [PubMed]
     [Google Scholar]
  2. Patel K, Clifford DB. Bacterial brain abscess. Neurohospitalist 2014; 4:196–204 [View Article] [PubMed]
     [Google Scholar]
  3. Brouwer MC, Coutinho JM, Van De Beek D. Clinical characteristics and outcome of brain abscess: systematic review and meta-analysis. Neurology 2014; 82:806–813 [View Article] [PubMed]
     [Google Scholar]
  4. Fallahian A, Desai N, Jackson MA, Decarrie JC, Rivard DC. Ostemyelitis of the clivus due to Fusobacterium necrophorum. Int J Case Reports Images 2012; 2:17
     [Google Scholar]
  5. Gregory SW, Boyce TG, Noelle Larson A, Patel R, Jackson MA. Fusobacterium nucleatum osteomyelitis in 3 previously healthy children: A case series and review of the literature. J Pediatric Infect Dis Soc 2015; 4:e155–9 [View Article] [PubMed]
     [Google Scholar]
  6. Williams A, Kerkering T. Prevotella osteomyelitis after dental capping procedure. IDCases 2017; 8:32–33 [View Article] [PubMed]
     [Google Scholar]
  7. Oka K, Nakano Y, Sazumi Y, Michitani T, Horiguchi S et al. Clival osteomyelitis with cavernous sinus thrombosis due to fusobacterium nucleatum and campylobacter rectus induced by tooth extraction. Intern Med 2018; 57:3325–3328 [View Article] [PubMed]
     [Google Scholar]
  8. Lange N, Gempt J. Fungal brain infection — no longer a death sentence. Neurosurg Rev 2021; 44:2239–2244 [View Article] [PubMed]
     [Google Scholar]
  9. Sherlock M, O’Sullivan E, Agha A, Behan LA, Owens D et al. Incidence and pathophysiology of severe hyponatraemia in neurosurgical patients. Postgrad Med J 2009; 85:171–175 [View Article] [PubMed]
     [Google Scholar]
  10. Kucharczyk W, Truwit CL. Diseases of the Sella Turcica and Parasellar Region. In Hodler J, Kubik-Huch RA, on Schulthess GK. eds Diseases of the Brain, Head and Neck, Spine 2020–2023: Diagnostic Imaging Springer; 2020 pp 3–9
     [Google Scholar]
  11. Brennan CA, Garrett WS. Fusobacterium nucleatum — symbiont, opportunist and oncobacterium. Nat Rev Microbiol 2019; 17:156–166 [View Article] [PubMed]
     [Google Scholar]
  12. Han XY, Weinberg JS, Prabhu SS, Hassenbusch SJ, Fuller GN et al. Fusobacterial brain abscess: A review of five cases and an analysis of possible pathogenesis. J Neurosurg 2003; 99:693–700 [View Article] [PubMed]
     [Google Scholar]
  13. Kuppalli K, Livorsi D, Talati NJ, Osborn M. Lemierre’s syndrome due to Fusobacterium necrophorum. Lancet Infect Dis 2012; 12:808–815 [View Article] [PubMed]
     [Google Scholar]
  14. Dahya V, Patel J, Wheeler M, Ketsela G. Fusobacterium nucleatum endocarditis presenting as liver and brain abscesses in an immunocompetent patient. Am J Med Sci 2015; 349:284–285 [View Article] [PubMed]
     [Google Scholar]
  15. Chaudhry R, Dhawan B, Laxmi BVJ, Mehta VS. The microbial spectrum of brain abscess with special reference to anaerobic bacteria. Br J Neurosurg 1998; 12:127–130 [View Article] [PubMed]
     [Google Scholar]
  16. Han SR, Choi CY, Kwak JJ. Prevotella brain abscess in a healthy young patient with a patent foramen ovale. Clin Neurol Neurosurg 2016; 142:128–131 [View Article] [PubMed]
     [Google Scholar]
  17. Zhang MJ, Cao XJ, Fan J, Yin ZG, Yu K. Corynebacterium striatum meningitis combined with suspected brain and lung abscesses: A case report and review. BMC Infect Dis 2020; 20:1–4
     [Google Scholar]
  18. Eshwara VK, Munim F, Shetty A, Gupta A, Nitin J et al. Corynebacterium minutissimum infecting pseudomeningocele: A rare case. J Microbiol Immunol Infect 2014; 47:149–151 [View Article] [PubMed]
     [Google Scholar]
  19. Chung S, Kim JS, Seo SW, Ra EK, Joo SI et al. A case of brain abscess caused by Propionibacterium acnes 13 months after neurosurgery and confirmed by 16S rRNA gene sequencing. Korean J Lab Med 2011; 31:122–126 [View Article] [PubMed]
     [Google Scholar]
  20. Prieto R, Callejas-Díaz A, Hassan R, De Vargas AP, López-Pájaro LF. Parvimonas micra: A potential causative pathogen to consider when diagnosing odontogenic brain abscesses. Surg Neurol Int 2020; 11:140 [View Article] [PubMed]
     [Google Scholar]
  21. Ling X, Zhu T, Luo Z, Zhang Y, Chen Y et al. A review of pituitary abscess: Our experience with surgical resection and nursing care. Transl Cancer Res 2017; 6:852–859 [View Article]
     [Google Scholar]
  22. Liu Y, Liu F, Liang Q, Li Y, Wang Z. Pituitary abscess: Report of two cases and review of the literature. Neuropsychiatr Dis Treat 2017; 13:1521–1526 [View Article] [PubMed]
     [Google Scholar]
  23. He J, Lam JCL, Adlan T. Clival osteomyelitis and hypoglossal nerve palsy-rare complications of Lemierre’s syndrome. BMJ Case Rep 2015; 2015:3–5
     [Google Scholar]
  24. Dow SW, LeCouteur RA, Henik RA, Jones RL, Poss ML. Central nervous system infection associated with anaerobic bacteria in two dogs and two cats. J Vet Intern Med 1988; 2:171–176 [View Article] [PubMed]
     [Google Scholar]
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Erosion of the sella turcica and pituitary expansion secondary to polymicrobial brain abscesses: a case report
Access Microbiology 3, 000270 (2021); https://doi.org/10.1099/acmi.0.000270
/content/journal/acmi/10.1099/acmi.0.000270
/content/journal/acmi/10.1099/acmi.0.000270
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