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.

journal_name

Swiss Med Wkly

journal_title

Swiss medical weekly

authors

Darling KE,Niederhauser J,Bervini D,Giulieri S,Daniel RT,Bille J,Erard V

doi

10.4414/smw.2012.13697

subject

Has Abstract

pub_date

2012-10-29 00:00:00

pages

w13697

eissn

1424-7860

issn

1424-3997

pii

smw-13697

journal_volume

142

pub_type

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