Rathke's cleft cyst abscess from Klebsiella

Abstract

Pituitary abscesses are uncommon lesions accounting for <1% of all pituitary diseases. We report a case of a female microbiology technician with a rare congenital heart disease who developed an Rathke's Cleft Cyst abscess from Klebsiella. A 26-year-old female biotechnician with a history of congenital heart disease and subclinical immunosuppression presented with a 10-month history of weight loss, amenorrhea, and visual deterioration. There was a history of previous unsuccessful transsphenoidal surgery. Radiology revealed a cystic lesion in the sellar region. The patient underwent an endoscopic endonasal intervention and the cystic cavity was washed with gentamicin, and the patient received meropenem postoperatively. The patient was followed up and had gradual improvement in her overall health, complete normality of her menstrual cycle, her visual field recovering to near normal and improving, no recurrence, and a stable cyst on magnetic resonance imaging.

Keywords: Abscess; Klebsiella; Pituitary abscess; Rathke’s cleft cyst.

Figure 1:

Pre-operative MRI. (a) coronal T1 with contrast, (b) axial T1 with contrast, (c) T2 sequence. MRI confirmed a 2.1 × 2.5 × 2.8 cm cystic mass in the sellar/suprasellar region with thick peripheral wall enhancement without visualization of normal pituitary. The lesion’s maximum thickness was 4 mm anteriorly. T2 signals demonstrate hyperintensity.

Figure 2:

Immediate post-operative (a) T1 coronal, (b) fluid-attenuated inversion recovery (FLAIR) sequence, (c) T2 sequence. There is near complete drainage of the cyst cavity with a decompressed optic chiasm but a suspicion of small residual fluid volume present on FLAIR but not appreciable on T2.