Katoh Nagaaki, Machida Kazuko, Satoh Syunichi, Yahikozawa Hiroyuki, Ikeda Shu-Ichi
Department of Neurology, Nagano Red Cross Hospital.
Rinsho Shinkeigaku. 2007 Jul;47(7):419-22.
A 55-year-old woman was admitted to our hospital complaining of severe headache with fever and apparent neck stiffness. Neutrophilic pleocytosis was demonstrated in cerebrospinal fluid (CSF) and bacterial meningitis was strongly suspected, but bacterial culture of CSF was negative. After the symptoms normalized within a few days, she developed diabetes insipidus and gadolinium (Gd)-enhancement of the enlarged hypophysis and stalk was observed on cranial MRI. A Lymphocytic Hypophysitis (LH) was clinically diagnosed. Follow-up studies demonstrated spontaneous remission of serological, radiological, and CSF findings, and she was discharged on hormonal replacement therapy with desmopressin. Three months later, she returned to our hospital complaining of headache again under adenohypophysial hypofunction and expanding pituitary lesion on MRI. CSF analysis showed meningitis but there was no evidence of infection by microorganisms. Our diagnosis was relapsing LH with aseptic meningitis, and the patient was administered methylprednisolone pulse therapy, which induced rapid improvement in clinical, endocrinological, and radiological findings. This case showed a possible unique clinical presentation of LH characterized as recurrent aseptic meningitis. It is important to recognize this phenotype of LH, and to prescribe corticosteroid therapy after appropriate endocrinological and radiological studies.
一名55岁女性因严重头痛伴发热及明显颈部僵硬入住我院。脑脊液（CSF）检查显示中性粒细胞增多，高度怀疑细菌性脑膜炎，但CSF细菌培养结果为阴性。数天后症状缓解，随后她出现尿崩症，头颅磁共振成像（MRI）显示垂体增大及垂体柄钆（Gd）强化。临床诊断为淋巴细胞性垂体炎（LH）。随访研究显示血清学、影像学及CSF检查结果均自发缓解，她出院时接受去氨加压素激素替代治疗。三个月后，她因腺垂体功能减退及MRI显示垂体病变扩大再次入住我院，诉头痛。CSF分析显示为脑膜炎，但未发现微生物感染证据。我们的诊断为复发性LH伴无菌性脑膜炎，给予患者甲泼尼龙冲击治疗，临床、内分泌及影像学检查结果迅速改善。该病例显示了LH可能具有的以复发性无菌性脑膜炎为特征的独特临床表现。认识LH的这种表型，并在进行适当的内分泌及影像学检查后给予皮质类固醇治疗很重要。
