CASE REPORT - BRAIN TUMORS Chemical meningitis from a leaking craniopharyngioma: a case report David Hakizimana 1 & Lars Poulsgaard 2 & Kåre Fugleholm 2 Received: 5 January 2018 /Accepted: 4 April 2018 # Springer-Verlag GmbH Austria, part of Springer Nature 2018 Abstract Recurrent chemical meningitis from cyclic leakage of cyst content from a craniopharyngioma is a rare phenomenon. Here, we report a case of leaking cystic craniopharyngioma presenting with recurrent episodes of sterile meningitis, depression, and paranoia. The diagnosis after an initial craniotomy and exploration was hypophysitis. Signs and symptoms were not alleviated by puncture and biopsy of the tumour but they disappeared after complete resection with a final histological diagnosis of craniopharyngioma. Keywords Leak . Craniopharyngioma . Chemical . Sterile . Meningitis Abbreviations MRI Magnetic resonance imaging CT Computed tomography DNA Deoxyribonucleic acid CNS Central nervous system CSF Cerebrospinal fluid WCC White cell count Introduction Craniopharyngiomas often present with pressure-related symptoms like visual deterioration, disturbance of the hypothalamic-pituitary axis, and hydrocephalus [1] but they can also present with chemical meningitis. Chemical menin- gitis due to craniopharyngioma is secondary to a rupture of the cystic component of the tumour, which may be demonstrated by a change in size and/or shape of the cyst on brain MRI or CT scan [2]. However, few cases of chemical meningitis caused by craniopharyngioma without any change noticed on imaging features of the tumour have been described [3–5]. In these rare cases, leakage from the tumour causes chemical meningitis, usually with a recurrent pattern. We re- port a case of recurrent episodes of fever, of depression, and of paranoid behaviour presumably caused by the effect of the leakage, as symptoms resolved completely after surgical re- section of the craniopharyngioma and hormone replacement therapy. Case presentation A 53-year-old man was complaining of increased urinary fre- quency and temperature fluctuations. In the year before referral to the neurosurgical service, he had recurrent febrile episodes with temperature up to 39 °C. He reported to have increased urinary frequency/nocturia and to have sudden-onset holocephalic headache during febrile episodes. Seven months prior to the first consultation, he was seen by a psychiatrist and was treated for depression and paranoid personality disorder. On physical examination, he was neurologically intact. His MRI showed a suprasellar predominantly cystic lesion with heterogeneous contrast enhancement. First surgery The lesion was exposed with a standard subfrontal approach and found to have a whitish appearance and a firm wall. A small hole was made in the cyst wall and a white pus-like substance was seen, with a striking similarity to a recent case of hypophysitis treated by the senior authors [6]. All the fluid was drained and the cavity was thoroughly washed out with * David Hakizimana semaragde@gmail.com 1 Rwanda Neurosurgical Center, Department of Surgery, King Faisal Hospital, P.O. Box: 2534, Kigali, Rwanda 2 Department of Neurosurgery, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark Acta Neurochirurgica https://doi.org/10.1007/s00701-018-3530-z