A case of bacterial sphenoid sinusitis accompanied by a pituitary abscess
A case of bacterial sphenoid sinusitis accompanied by a pituitary abscess
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细菌性蝶窦炎伴垂体脓肿一例
DOI：
10.1016/j.xocr.2022.100432
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发表时间：
2022
影响因子：
--
通讯作者：
Okano Mitsuhiro
中科院分区：
文献类型：
--
作者：
Oka Aiko;Akamatsu Maki;Kanai Kengo;Watanabe Yoshihiro;Imanishi Yorihisa;Noguchi Yoshihiro;Yano Harumi;Kiryu Shigeru;Shiomi Takayuki;Okano Mitsuhiro
蝶窦毗邻海绵窦、垂体腺、视神经和颈内动脉，蝶窦炎可引起这些周围结构的各种炎症。然而，鼻窦炎的颅内并发症相当罕见。我们经历了一例鼻窦炎合并脑下垂体脓肿。，一名患有失控糖尿病的男性，主诉疲劳，血液检查显示可能是肾上腺功能不全。补充类固醇治疗改善了他的症状。患者随后因左侧外展神经麻痹而出现复视，随后的头部增强磁共振成像(MRI)显示左侧蝶窦炎、左侧海绵窦炎、毗邻海绵窦的硬膜外脓肿和鞍内垂体脓肿。立即给予万古霉素(2g/d)、头孢吡肟(6g/d)、甲硝唑(1.5g/d)抗生素治疗，并行左侧鼻窦内窥镜手术(ESS)。组织学检查显示腐蚀性粘膜中有真菌生长，但仅存在于粘膜表面，我们将其病理生理学评估为细菌感染而不是侵袭性真菌感染。ESS期间从蝶窦引流的脓液的细菌、真菌和分枝杆菌培养试验均为阴性。ESS和抗生素治疗6周，如用于治疗骨髓炎，改善了MRI表现和左眼运动。尽管抗生素疗法的发展，颅内脓肿患者的预后仍然很差。然而，据报道，早期诊断可以减少死亡率和残留神经功能障碍的发生率，应该考虑早期增强MRI。
The sphenoid sinus is adjacent to the cavernous sinus, pituitary gland, optic nerve, and internal carotid artery, and sphenoid sinusitis can cause various inflammation of these surrounding structures. However, intracranial complications of sinusitis are quite rare. We experienced a case of sinusitis with a pituitary abscess. A 64-year-old man with uncontrolled diabetes complained of fatigue, and blood tests revealed possible adrenal insufficiency. Supplementary steroid treatment improved his symptom. The patient then experienced diplopia due to left abducens nerve paralysis, and subsequent enhanced magnetic resonance imaging (MRI) of the head revealed left sphenoid sinusitis, left cavernous sinus inflammation, an epidural abscess contiguous to the cavernous sinus, and an intra-sellar pituitary abscess. Antibiotic treatment with vancomycin (2 g/day), cefepime (6 g/day), and metronidazole (1.5 g/day) was started immediately, and left-side endoscopic sinus surgery (ESS) was performed. Histological examination revealed fungal growth in the erosive mucosa, but it was present only on the surface of the mucosa, and we assessed the pathophysiology as a bacterial infection rather than an invasive fungal infection. Culture tests of the pus drained from the sphenoid sinus during ESS were negative for bacteria, fungi, and mycobacteria. ESS and antibiotic treatment for 6 weeks, as is used for treating osteomyelitis, improved the MRI findings and left eye movement. Despite the development of antibiotic treatments, the prognosis of patients with intracranial abscess remains poor. However, early diagnosis has been reported to reduce the mortality and residual neurologic disturbance rates, and early enhanced MRI should be considered.
影响因子：
2.6
作者：
Miller, Craig;Suh, Jeffrey D.;Chiu, Alexander G.
通讯作者：
Chiu, Alexander G.
影响因子：
2
作者：
Hsu, Che-Wei;Tsai, Wan-Chen;Chang, Wen-Neng
通讯作者：
Chang, Wen-Neng