{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,2,24]],"date-time":"2026-02-24T17:28:43Z","timestamp":1771954123775,"version":"3.50.1"},"reference-count":27,"publisher":"Scientific Scholar","content-domain":{"domain":["surgicalneurologyint.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec id=\"st1\">\n<jats:title>Background: <\/jats:title>\n<jats:p>Pituitary abscess (PA) can be fatal if diagnosed late. Rim enhancement is a typical radiological finding of PA on postgadolinium T1-weighted magnetic resonance imaging (MRI). Diffusion-weighted imaging is helpful in distinguishing PA from other sellar cystic lesions. Herein, we report the first atypical case of PA showing neither rim enhancement nor diffusion restriction with an unusual organism, <jats:italic>Moraxella catarrhalis<\/jats:italic>.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st2\">\n<jats:title>Case Description: <\/jats:title>\n<jats:p>A 77-year-old woman presented with headache, polyuria, polydipsia, and fatigue for a month before presenting to a local hospital. MRI showed pituitary enlargement with contrast enhancement. She had neither fever nor visual deficits and was followed up with hormonal replacement. Six months later, she complained of visual impairment, and MRI showed further pituitary enlargement with a thickened stalk compressing the optic chiasma. Neither rim enhancement nor diffusion restriction was observed. Endoscopic endonasal transsphenoidal surgery was performed based on the radiological diagnosis of lymphocytic hypophysitis or pituitary tumors. A thick, creamy yellow pus was drained from the sellar lesion. Intraoperative rapid histopathological findings revealed polymorphonuclear leukocytes infiltrating the pituitary gland. PA was diagnosed, and irrigation and open drainage of the abscess was performed. Bacterial culture of the pus detected <jats:italic>M. catarrhalis<\/jats:italic> by mass spectrometer, confirming the diagnosis. She underwent appropriate antibiotic administration, and her visual deficits improved.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"st3\">\n<jats:title>Conclusion: <\/jats:title>\n<jats:p>We report the first atypical case of PA showing neither rim enhancement nor diffusion restriction with <jats:italic>M. catarrhalis<\/jats:italic>. Even if preoperative findings are not suggestive of PA, it should be considered as a differential diagnosis. Intraoperative rapid histopathological findings are useful for accurately diagnosing PA and initiating appropriate surgical treatment.<\/jats:p>\n<\/jats:sec>","DOI":"10.25259\/sni_835_2021","type":"journal-article","created":{"date-parts":[[2021,12,20]],"date-time":"2021-12-20T05:58:24Z","timestamp":1639979904000},"page":"617","update-policy":"https:\/\/doi.org\/10.25259\/crossmark_policy","source":"Crossref","is-referenced-by-count":6,"title":["Atypical pituitary abscess lacking rim enhancement and diffusion restriction with an unusual organism, <i>Moraxella catarrhalis<\/i>: A case report and review of the literature"],"prefix":"10.25259","volume":"12","author":[{"given":"Tatsuya","family":"Kawano","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Naoki","family":"Shinojima","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Satoko","family":"Hanatani","sequence":"additional","affiliation":[{"name":"Department of Metabolic Medicine, Kumamoto University Hospital, Kumamoto, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eiichi","family":"Araki","sequence":"additional","affiliation":[{"name":"Department of Metabolic Medicine, Kumamoto University Hospital, Kumamoto, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yoshiki","family":"Mikami","sequence":"additional","affiliation":[{"name":"Department of Diagnostic Pathology, Kumamoto University Hospital, Kumamoto, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akitake","family":"Mukasa","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Kumamoto University Hospital, Kumamoto, Japan."}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"10894","published-online":{"date-parts":[[2021,12,20]]},"reference":[{"key":"10.25259\/SNI_835_2021\/ref-1","doi-asserted-by":"crossref","first-page":"282","DOI":"10.1177\/197140090702000305","article-title":"Diffusion weighted MRI of primary pituitary abscess. Case report","volume":"20","author":"Anik","year":"2007","journal-title":"Neuroradiol J"},{"key":"10.25259\/SNI_835_2021\/ref-2","doi-asserted-by":"crossref","first-page":"333","DOI":"10.1148\/radiology.212.2.r99au36333","article-title":"Acute cerebral infarction: Quantification of spin-density and T2 shine-through phenomena on diffusion-weighted MR images","volume":"212","author":"Burdette","year":"1999","journal-title":"Radiology"},{"key":"10.25259\/SNI_835_2021\/ref-3","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1007\/s11102-006-8327-z","article-title":"Pituitary abscess: Report of four cases and review of literature","volume":"9","author":"Dutta","year":"2006","journal-title":"Pituitary"},{"key":"10.25259\/SNI_835_2021\/ref-4","doi-asserted-by":"crossref","first-page":"299","DOI":"10.1007\/s11102-007-0057-3","article-title":"Pituitary abscess: Our experience with a case and a review of the literature","volume":"11","author":"Dalan","year":"2008","journal-title":"Pituitary"},{"key":"10.25259\/SNI_835_2021\/ref-5","doi-asserted-by":"crossref","first-page":"887","DOI":"10.1007\/BF03343947","article-title":"Magnetic resonance imaging and computerized tomography images in a case of pituitary abscess","volume":"24","author":"Erdogan","year":"2001","journal-title":"J Endocrinol Invest"},{"key":"10.25259\/SNI_835_2021\/ref-6","first-page":"333","article-title":"Encephalitis, cerebritis, and brain abscess: Pathophysiology and imaging findings","volume":"10","author":"Falcone","year":"2000","journal-title":"Neuroimaging Clin N Am"},{"key":"10.25259\/SNI_835_2021\/ref-7","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1007\/s11102-016-0757-7","article-title":"Pituitary abscess: Clinical manifestations, diagnosis and treatment of 66 cases from a large pituitary center over 23 years","volume":"20","author":"Gao","year":"2017","journal-title":"Pituitary"},{"key":"10.25259\/SNI_835_2021\/ref-8","doi-asserted-by":"crossref","first-page":"1073","DOI":"10.2214\/ajr.152.5.1073","article-title":"MR imaging of brain abscess","volume":"152","author":"Haimes","year":"1989","journal-title":"AJR Am J Roentgenol"},{"key":"10.25259\/SNI_835_2021\/ref-9","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1007\/s11102-015-0651-8","article-title":"Intrasellar abscess following pituitary surgery","volume":"18","author":"Huang","year":"2015","journal-title":"Pituitary"},{"key":"10.25259\/SNI_835_2021\/ref-10","doi-asserted-by":"crossref","first-page":"280","DOI":"10.1097\/PAF.0b013e3182557dcf","article-title":"Pituitary abscess presenting a very rapid progression: Report of a fatal case","volume":"33","author":"Kotani","year":"2012","journal-title":"Am J Forensic Med Pathol"},{"key":"10.25259\/SNI_835_2021\/ref-11","article-title":"Medical Microbiology and Immunology","author":"Levinson","year":"1998"},{"key":"10.25259\/SNI_835_2021\/ref-12","doi-asserted-by":"crossref","first-page":"650","DOI":"10.20471\/acc.2016.55.04.17","article-title":"Pituitary abscess with unusual clinical course","volume":"55","author":"Medic Stojanoska","year":"2016","journal-title":"Acta Clin Croat"},{"key":"10.25259\/SNI_835_2021\/ref-13","doi-asserted-by":"crossref","first-page":"785","DOI":"10.3171\/jns.1972.36.6.0785","article-title":"Pituitary abscess in a craniopharyngioma. Case report","volume":"36","author":"Obrador","year":"1972","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_835_2021\/ref-14","doi-asserted-by":"crossref","first-page":"240.e13","DOI":"10.1016\/j.wneu.2012.11.064","article-title":"A rare case of recurrent frontal osteoma complicated by mucopyocele with an unusual organism, Moraxella catarrhalis","volume":"82","author":"Ramakrishna","year":"2014","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_835_2021\/ref-15","first-page":"196","article-title":"CT and MRI findings in primitive pituitary abscess: A case report and review of literature","volume":"26","author":"Sabbah","year":"1999","journal-title":"J Neuroradiol"},{"key":"10.25259\/SNI_835_2021\/ref-16","doi-asserted-by":"crossref","first-page":"1423","DOI":"10.1007\/s00381-021-05052-8","article-title":"Primary pituitary abscess in an adolescent female patient: Case report, literature review, and operative video","volume":"37","author":"Sherrod","year":"2021","journal-title":"Childs Nerv Syst"},{"key":"10.25259\/SNI_835_2021\/ref-17","doi-asserted-by":"crossref","first-page":"226","DOI":"10.1007\/BF01989185","article-title":"On embolic processes in the pituitary gland","volume":"217","author":"Simmonds","year":"1914","journal-title":"Virchows Arch Path Anat"},{"key":"10.25259\/SNI_835_2021\/ref-18","doi-asserted-by":"crossref","first-page":"467","DOI":"10.1016\/j.wneu.2017.10.060","article-title":"Endoscopic endonasal transsphenoidal drainage of a spontaneous candida glabrata pituitary abscess","volume":"109","author":"Strickland","year":"2018","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_835_2021\/ref-19","doi-asserted-by":"crossref","first-page":"683","DOI":"10.2169\/internalmedicine.51.6589","article-title":"Diffusion-weighted MRI findings in a patient with pituitary abscess","volume":"51","author":"Taguchi","year":"2012","journal-title":"Intern Med"},{"key":"10.25259\/SNI_835_2021\/ref-20","doi-asserted-by":"crossref","first-page":"514","DOI":"10.1097\/00004728-200605000-00028","article-title":"Diffusion-weighted magnetic resonance imaging in pituitary abscess","volume":"30","author":"Takao","year":"2006","journal-title":"J Comput Assist Tomogr"},{"key":"10.25259\/SNI_835_2021\/ref-21","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1007\/s10143-006-0021-0","article-title":"A pituitary abscess showing high signal intensity on diffusion-weighted imaging","volume":"29","author":"Takayasu","year":"2006","journal-title":"Neurosurg Rev"},{"key":"10.25259\/SNI_835_2021\/ref-22","doi-asserted-by":"crossref","first-page":"233","DOI":"10.3171\/jns.2001.95.2.0233","article-title":"Diagnosis and management of pituitary abscess: A review of twenty-four cases","volume":"95","author":"Vates","year":"2001","journal-title":"J Neurosurg"},{"key":"10.25259\/SNI_835_2021\/ref-23","doi-asserted-by":"crossref","first-page":"130","DOI":"10.1016\/S0163-4453(98)93774-4","article-title":"Brain abscess caused by infection with Moraxella catarrhalis following a penetrating injury","volume":"36","author":"Viagappan","year":"1998","journal-title":"J Infect"},{"key":"10.25259\/SNI_835_2021\/ref-24","doi-asserted-by":"crossref","first-page":"e900","DOI":"10.1016\/j.wneu.2018.03.113","article-title":"Magnetic resonance imaging characteristics of pituitary abscess: A review of 51 cases","volume":"114","author":"Wang","year":"2018","journal-title":"World Neurosurg"},{"key":"10.25259\/SNI_835_2021\/ref-25","doi-asserted-by":"crossref","first-page":"909","DOI":"10.1016\/j.crad.2014.04.012","article-title":"Can diffusion-weighted imaging be used to differentiate brain abscess from other ring-enhancing brain lesions? A meta-analysis","volume":"69","author":"Xu","year":"2014","journal-title":"Clin Radiol"},{"key":"10.25259\/SNI_835_2021\/ref-26","doi-asserted-by":"crossref","first-page":"957","DOI":"10.1016\/j.clineuro.2012.02.020","article-title":"Diagnosis and minimally invasive surgery for the pituitary abscess: A review of twenty nine cases","volume":"114","author":"Zhang","year":"2012","journal-title":"Clin Neurol Neurosurg"},{"key":"10.25259\/SNI_835_2021\/ref-27","first-page":"1","article-title":"Neuroimaging of cerebral abscesses","volume":"1","author":"Zimmerman","year":"1991","journal-title":"Neuroimaging Clin North Am"}],"container-title":["Surgical Neurology International"],"original-title":[],"language":"en","link":[{"URL":"http:\/\/surgicalneurologyint.com\/atypical-pituitary-abscess-lacking-rim-enhancement-and-diffusion-restriction-with-an-unusual-organism-a-case-report-and-review-of-the-literature\/","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/atypical-pituitary-abscess-lacking-rim-enhancement-and-diffusion-restriction-with-an-unusual-organism-a-case-report-and-review-of-the-literature\/","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,20]],"date-time":"2021-12-20T05:59:03Z","timestamp":1639979943000},"score":1,"resource":{"primary":{"URL":"http:\/\/surgicalneurologyint.com\/surgicalint-articles\/atypical-pituitary-abscess-lacking-rim-enhancement-and-diffusion-restriction-with-an-unusual-organism-a-case-report-and-review-of-the-literature\/"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,20]]},"references-count":27,"alternative-id":["10.25259\/SNI_835_2021"],"URL":"https:\/\/doi.org\/10.25259\/sni_835_2021","relation":{},"ISSN":["2152-7806"],"issn-type":[{"value":"2152-7806","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,20]]},"article-number":"617"}}