ISSN 1470-3947 (print) | ISSN 1479-6848 (online)

Endocrine Abstracts (2007) 14 P486

Persistent fever after surgical removal of a craniopharyngioma: diagnosis pitfalls and therapeutic difficulties

Raluca Alexandra Trifanescu1, Monica Livia Gheorghiu1, Irina Ogrezean2, Vasile Ciubotaru2, Daniela Preotescu3, Rudolf Fahlbusch4 & Mihail Coculescu1

1Department of Endocrinology, ‘Carol Davila’ University of Medicine and Pharmacy, Bucharest, Romania; 2‘Bagdasar Arseni’ Neurosurgery Hospital, Bucharest, Romania; 3‘Matei Bals’ Institute of Infectious Diseases, Bucharest, Romania; 4Endocrine Neurosurgery Department, International Neuroscience Institute, Hannover, Germany.

Background: Thermoregulatory disorders after neurosurgery of craniopharingyomas were seldom reported.

Aim: To present the difficulties of etiologic diagnosis and treatment of a persistent febrile syndrome in a patient with surgically removed craniopharyngioma.

Patient and methods: A 34 years old man with a giant craniopharyngioma situated in the basal-anterior part of the third ventricle is reported. Anterior pituitary hormones were measured by fluoroimmunoassay. MRI, CT, X-rays were used for imaging. Cultures from various biologic fluids were performed.

Results: The patient underwent two successive transfrontal neurosurgical interventions. Postsurgery, diabetes insipidus and panhypopituitarism occurred. Substitutive hormonal therapy was introduced. After the second operation, the patient presented fever (up to 39  °C), abdominal pains, hypodypsia with hypernatremia and hyperphagia. Suspected colitis was excluded by colonoscopy. Thereafter, the patient developed a left inferior pneumonia complicated with minimal pleuresia; the bronchial aspirate identified Klebsiella pneumoniae and the patient received antibiotics according to the antibiogram. The pneumonic and pleural opacities on X-rays and on CT scan resumed, but the fever persisted. No inflammation markers were noticed: normal C reactive protein (0.52 mg/dL) and fibrinogen (391 mg/dL) levels, negative procalcitonine. Repeated hemocultures and cerebrospinal fluid cultures were negative. The urocultures and the cultures from the ventriculo-subcutaneous shunts were also negative. The fever persisted despite intensive, wide spectrum antibiotherapy, combined tuberculostatic therapy or high doses of corticosteroids. Excluding the infection, we conclude that the fever had central origin.

Conclusion: Hypothalamic thermoregulatory dysfunction with fever should be considered in patients with surgically removed craniopharyngiomas of the third ventricle.

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