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Cryptococcal meningitis after transnasal transsphenoidal pituitary microsurgery of ACTH-secreting pituitary adenoma: A case report

RATIONALE: Microbial infection should be regarded in the differential diagnosis of neurosurgical complications after transnasal transsphenoidal pituitary microsurgery, albeit cryptococcal meningitis is rare. This article will discuss the risk factors of cryptococcal meningitis in patients underwent...

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Autores principales: Liu, Yang, Feng, Ming, Yao, Yong, Deng, Kan, Bao, Xinjie, Liu, Xiaohai, Wang, Renzhi
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer Health 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5515736/
https://www.ncbi.nlm.nih.gov/pubmed/28700464
http://dx.doi.org/10.1097/MD.0000000000007124
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author Liu, Yang
Feng, Ming
Yao, Yong
Deng, Kan
Bao, Xinjie
Liu, Xiaohai
Wang, Renzhi
author_facet Liu, Yang
Feng, Ming
Yao, Yong
Deng, Kan
Bao, Xinjie
Liu, Xiaohai
Wang, Renzhi
author_sort Liu, Yang
collection PubMed
description RATIONALE: Microbial infection should be regarded in the differential diagnosis of neurosurgical complications after transnasal transsphenoidal pituitary microsurgery, albeit cryptococcal meningitis is rare. This article will discuss the risk factors of cryptococcal meningitis in patients underwent transnasal transsphenoidal pituitary microsurgery, and summary the potential origins of infection. PATIENT CONCERNS AND DIAGNOSIS: Here, we report a case of 37-year-old male who had cryptococcal meningitis after transnasal transsphenoidal pituitary microsurgery of a relapsing ACTH-secreting pituitary adenoma. INTERVENTION: Standard therapy for Cryptococcus neoformans (fluconazole [400 mg per day] and flucytosine) was administered and followed by maintenance dose. OUTCOMES: The patient had been on treatment for one and a half years during follow-up and reported neurologically well with repeated negative cerebrospinal fluid (CSF) culture until sudden death of heart arrest. MAIN LESSONS TO LEARN: C neoformans can be a possible cause of meningitis in immunocompetent patients after transnasal transsphenoidal pituitary microsurgery. Risk factors, such as pre-existed pulmonary infection and Cushing-associated hypercortisolemia, should be stressed. Promising preventive measures may include preoperative routine sputum smear and India-ink stain for screening, preoperative treatment of cryptococcal pneumonia, postoperative antibiotic management, and a more secure skull base reconstruction. Radiation and pharmaceutical treatment may be alternative for recurrent Cushing disease.
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spelling pubmed-55157362017-07-28 Cryptococcal meningitis after transnasal transsphenoidal pituitary microsurgery of ACTH-secreting pituitary adenoma: A case report Liu, Yang Feng, Ming Yao, Yong Deng, Kan Bao, Xinjie Liu, Xiaohai Wang, Renzhi Medicine (Baltimore) 7100 RATIONALE: Microbial infection should be regarded in the differential diagnosis of neurosurgical complications after transnasal transsphenoidal pituitary microsurgery, albeit cryptococcal meningitis is rare. This article will discuss the risk factors of cryptococcal meningitis in patients underwent transnasal transsphenoidal pituitary microsurgery, and summary the potential origins of infection. PATIENT CONCERNS AND DIAGNOSIS: Here, we report a case of 37-year-old male who had cryptococcal meningitis after transnasal transsphenoidal pituitary microsurgery of a relapsing ACTH-secreting pituitary adenoma. INTERVENTION: Standard therapy for Cryptococcus neoformans (fluconazole [400 mg per day] and flucytosine) was administered and followed by maintenance dose. OUTCOMES: The patient had been on treatment for one and a half years during follow-up and reported neurologically well with repeated negative cerebrospinal fluid (CSF) culture until sudden death of heart arrest. MAIN LESSONS TO LEARN: C neoformans can be a possible cause of meningitis in immunocompetent patients after transnasal transsphenoidal pituitary microsurgery. Risk factors, such as pre-existed pulmonary infection and Cushing-associated hypercortisolemia, should be stressed. Promising preventive measures may include preoperative routine sputum smear and India-ink stain for screening, preoperative treatment of cryptococcal pneumonia, postoperative antibiotic management, and a more secure skull base reconstruction. Radiation and pharmaceutical treatment may be alternative for recurrent Cushing disease. Wolters Kluwer Health 2017-07-14 /pmc/articles/PMC5515736/ /pubmed/28700464 http://dx.doi.org/10.1097/MD.0000000000007124 Text en Copyright © 2017 the Author(s). Published by Wolters Kluwer Health, Inc. http://creativecommons.org/licenses/by-nd/4.0 This is an open access article distributed under the Creative Commons Attribution-NoDerivatives License 4.0, which allows for redistribution, commercial and non-commercial, as long as it is passed along unchanged and in whole, with credit to the author. http://creativecommons.org/licenses/by-nd/4.0
spellingShingle 7100
Liu, Yang
Feng, Ming
Yao, Yong
Deng, Kan
Bao, Xinjie
Liu, Xiaohai
Wang, Renzhi
Cryptococcal meningitis after transnasal transsphenoidal pituitary microsurgery of ACTH-secreting pituitary adenoma: A case report
title Cryptococcal meningitis after transnasal transsphenoidal pituitary microsurgery of ACTH-secreting pituitary adenoma: A case report
title_full Cryptococcal meningitis after transnasal transsphenoidal pituitary microsurgery of ACTH-secreting pituitary adenoma: A case report
title_fullStr Cryptococcal meningitis after transnasal transsphenoidal pituitary microsurgery of ACTH-secreting pituitary adenoma: A case report
title_full_unstemmed Cryptococcal meningitis after transnasal transsphenoidal pituitary microsurgery of ACTH-secreting pituitary adenoma: A case report
title_short Cryptococcal meningitis after transnasal transsphenoidal pituitary microsurgery of ACTH-secreting pituitary adenoma: A case report
title_sort cryptococcal meningitis after transnasal transsphenoidal pituitary microsurgery of acth-secreting pituitary adenoma: a case report
topic 7100
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5515736/
https://www.ncbi.nlm.nih.gov/pubmed/28700464
http://dx.doi.org/10.1097/MD.0000000000007124
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