Pituitary abscesses are rare. The case reported here concerns a 28-yea
r old African. Gradual development of diplopia over 6 months was the f
irst clinical manifestation. Three months later this development had r
eached a more severe and infectious context, with complete right ophth
almoplegia, meningitis and coma (GCS = 9). CT scan showed an image in
favour of a pituitary abscess with suprasellar extension, associated w
ith thrombophlebitis of the cavernous sinus. An antibiotic therapy con
sisting of cefotaxime and metronidazole administered for 1 month, and
netilmicine for 15 days succeeded in controlling the infectious syndro
me. This resulted in cure of visual disorders, reduction in size of th
e CT scan image and reconstruction of the pituitary sella which had be
en destroyed. The diagnosis of pituitary abscess should be made when c
onfronted with an infectious syndrome (unexplained fever, repeated men
ingitis). CT does not recognize the nature of the hypophyseal mass it
shows : necrosis of a pituitary adenoma, giant aneurysm or craniophary
ngioma may mimick local infection. Surgery confirms the diagnosis and
is regarded as the best treatment The patient's life is threatened whe
n meningitis is present, and the functional prognosis is poor when rec
overy from visual disorders is compromised due to late diagnosis. In t
his paper a comparative analysis of the clinical course of the disease
and therapeutic data in our patient is presented and compared with ot
her reported cases.