Unusual cause of pituitary abscess due to enterococcus faecalis: A case report

• Preoperative diagnosis of pituitary abscess remains challenging. • Diffusion-weighted MRI may lack typical restriction in sellar abscesses. • The use of 16S rRNA PCR improves bacterial identification in culture-negative cases. • Surgical drainage with targeted antibiotics ensures favorable outcomes. Pituitary abscess is a rare and life-threatening condition, representing less than 1% of all pituitary lesions. It may arise de novo or complicate pre-existing lesions. Early diagnosis through imaging and prompt surgical drainage with antibiotic therapy are essential to prevent serious complications. Microbiological identification is essential but not always achieved. Recurrent cases are rare and pose diagnostic and therapeutic challenges. A 32-year-old woman with type II diabetes presented with visual loss and amenorrhea due to a pituitary abscess. Initial sterile drainage and empirical antibiotics failed. Recurrence led to reoperation, revealing Enterococcus faecalis . Targeted antibiotics achieved clinical and radiological resolution. The patient remains asymptomatic after three years of follow-up. Lessons: This report underscores the importance of considering atypical pathogens in recurrent or unclear cases and highlights the need for repeated microbiological sampling. Prompt surgical drainage and targeted antibiotic therapy are crucial for favorable outcomes.