Background: Meningitis associated with untreated pituitary macroadenoma is rare and seldom reported. We present an unusual case of a patient with newly diagnosed Acromegaly who developed meningitis.

Case presentation: A 40-year-old woman with history of type 2 diabetes mellitus and hypertension presented with one week of fever and headache. On examination she was drowsy, had signs of meningeal irritation, and limitation of left eye movement. Brain CT revealed evidence of meningitis and a pituitary adenoma. She received antibiotic therapy and subsequently underwent transsphenoidal surgical removal of the pituitary adenoma. After treatment, her fever resolved and eye movement limitation improved. On further history, the patient reported amenorrhea, type 2 diabetes mellitus and hypertension since age 35, and had gradually developed enlargement of hands and feet and intermittent blurred vision — symptoms she had previously ignored. Laboratory tests showed elevated insulin-like growth factor-1 (IGF-1), and histopathology confirmed pituitary adenoma consistent with acromegaly.

After operation, patient vision , conscious improve , sugar and HTN also improve

Conclusions: This case underscores a rare but important association between newly diagnosed acromegaly and meningitis. Clinicians should be aware that pituitary macroadenoma in acromegaly can present with central nervous system infection. Early recognition and prompt neurosurgical management combined with antibiotic therapy may lead to favorable outcomes.