Intratumoral abscess in papillary type craniopharyngioma with meningitis: a case report

• Intratumoral abscess in craniopharyngioma is an extremely rare condition. • High clinical suspicion is paramount, especially when imaging results are inconclusive. • Delayed diagnosis can lead to improper pre-operative antibiotic use and an increased risk of sepsis. • Co-existing chronic sinusitis may favor the transcranial surgical approach for management. • There are no established management guidelines, necessitating further research and study. Pituitary abscess (PA) is a rare medical condition, and craniopharyngiomas complicated by pituitary abscesses are even less common. PA is an uncommon infection of the central nervous system (CNS). Many reports were of the primary type, originating from a normal pituitary gland. In contrast, few were reported to be of the secondary type with abnormal coexisting lesions such as pituitary adenoma, craniopharyngioma, or Rathke’s cleft cyst. Clinical presentations most commonly manifest as fever, altered consciousness, visual disturbances, and headaches, all of which may mimic pituitary apoplexy. Although craniopharyngiomas generally have a favorable prognosis, the formation of intratumoral abscesses can introduce additional morbidity. We present a case report of an 81-year-old Thai male who initially presented with visual disturbances for three months and later developed acute headaches with fever for two days. We aim to describe the patient’s clinical presentation, laboratory and radiological investigations, and all therapeutic managements performed during his course of treatment. Thus, although this condition remains rare, a high index of suspicion and early diagnosis can lead to prompt treatment and better patient outcomes.