Huge retrorectal cystic teratoma mimicking menengitis. A case report.

Osman Nuri Dilek1, Ahmet Hakan Halici2, Turan Acar2, Emine Ozlem Gur1, Oguzhan Ozsay2, Fulya Cakalagaoglu2, Sedat Altay2, Mehmet Haciyanli1. 1Izmir Katip Celebi University, School of Medicine, 2Ataturk Research and Education Hospital

Retrorectal primary mature cystic teratomas are extremely rare and can be challenging to diagnose and treat in adults. These lesions are frequently clinically unrecognized and misdiagnosed.

We present a case of a 39-year-old male patient with mature cystic teratoma presenting with repeated episodes of menengitis. He presented to our emergency department with complaints of fever, headache and vomiting since 15 days. Neurological examination showed that there was neck stiffness with positive Kernig and Brudzinski signs. On further enquiry, he described similar episodes twice in past.  Cerebrospinal fluid (CSF) analysis showed lymphocytosis and elevated proteins.  He was treated for initial diagnosis as tuberculosis menengitis by a specialist of infection disease with antibiotics after a CSF study which was culture negative.  Since he had recurrent menengitis, radiological investigations revealed by suggested it to be a retrorectal mature cyst 20 cm in diameter which may be related with the cerebrospinal fluid. He underwent a total cyst excision of the lesion and histopathology confirmed a mature cystic teratoma. The postoperative period was uneventful.

We identified about 25 cases of recurrent meningitis associated with dermoid and epidermoid cysts in the medline literature search. Here in, we discussed the diagnosis and treatment modalities in view of the literature.

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