Suzuki Keisuke, Izawa Naoki, Nakamura Toshiki, Hashimoto Kenichi, Ouchi Keita, Sakuta Hideki, Asakawa Yohei, Numao Ayaka, Hirata Koichi
Department of Neurology, Dokkyo Medical University, Japan.
Intern Med. 2011;50(18):2025-30. doi: 10.2169/internalmedicine.50.5386. Epub 2011 Sep 15.
A 66-year-old man was admitted to our hospital with muscle pain, fatigue and appetite loss that had lasted for a month. The patient was somnolent and had nuchal stiffness with a high fever. Cerebrospinal fluid (CSF) tests demonstrated lymphocytic pleocytosis with a decreased CSF-blood glucose ratio. The tests for tuberculous, fungal and carcinomatous meningitis and herpetic meningoencephalitis were negative. Endocrinological exams showed hypopituitarism and diabetes insipidus. A pituitary MRI showed an enlargement of the pituitary stalk. A diagnosis of lymphocytic hypophysitis with aseptic meningitis was made after the exclusion of secondary hypophysitis. Lymphocytic hypophysitis with aseptic meningitis can mimic subacute meningoencephalitis.
一名66岁男性因持续一个月的肌肉疼痛、疲劳和食欲减退入住我院。患者嗜睡，伴有颈部强直和高热。脑脊液（CSF）检查显示淋巴细胞增多，脑脊液-血液葡萄糖比值降低。结核性、真菌性、癌性脑膜炎及疱疹性脑膜脑炎检查均为阴性。内分泌检查显示垂体功能减退和尿崩症。垂体MRI显示垂体柄增粗。排除继发性垂体炎后，诊断为淋巴细胞性垂体炎伴无菌性脑膜炎。淋巴细胞性垂体炎伴无菌性脑膜炎可酷似亚急性脑膜脑炎。
