case_images: PMC10338657_01
case_images: Magnetic resonance imaging at the initial visit. The thickened pituitary stalk and the pituitary gland in relatively increased size (arrows) on T2-weighted sagittal (A) and coronal (B) images. Note the absence of high-intensity (bright) signals in the posterior pituitary lobe (arrow) on T1-weighted sagittal image with fat suppression (C) and marked homogeneous enhancement with gadolinium diethylenetriamine pentaacetic acid (DTPA) contrast in the whole pituitary gland and the stalk (arrows) on T1-weighted sagittal (D) and coronal (E) images.
case_images: 10.1177_23247096231186046-fig1.jpg
case_images: PMC10338657_01_10.1177_23247096231186046-fig1.jpg
case_images: fig1-23247096231186046
case_images: Head magnetic resonance imaging demonstrated the thickening of the pituitary stalk and the relatively increased size of the pituitary gland (Figure 1A and B), together with the absence of high-intensity (bright) signals in the posterior pituitary lobe on the T1-weighted image (Figure 1C). Homogeneous high enhancement was noted with gadolinium DTPA contrast in the whole pituitary gland and stalk, and was extending continuously to the neighboring bilateral cavernous sinus (Figure 1D and E), leading to the diagnosis of lymphocytic hypophysitis. Head magnetic resonance imaging showed that the pituitary gland and stalk decreased in size (Figure 3A and B), but showed persistent contrast enhancement (Figure 3C and D) as the same as the images 2 months previously (Figure 1D and F).
case_images: Fundus photographs and optical coherence tomography in the right eye (A and B) and left eye (C and D) at the initial visit to an ophthalmologist. Note hyperemic and blurred optic disks (black arrows) in both eyes (A and C) and isolated retinal periphlebitis (arrowhead) in the left eye (C). Swollen optic disks (white arrows) in both eyes are evident in horizontal sections of optical coherence tomography (B and D). Goldmann perimetry in the right eye (F) and left eye (E), showing narrowing-down of the upper central visual field in both eyes, a week after the visit to an ophthalmologist.
case_images: 10.1177_23247096231186046-fig2.jpg
case_images: PMC10338657_01_10.1177_23247096231186046-fig2.jpg
case_images: fig2-23247096231186046
case_images: The optic disks in both eyes were hyperemic, blurred, and swollen (Figure 2A-D), leading to the diagnosis of bilateral optic neuritis. The retinal manifestation was absent except for isolated retinal periphlebitis along the inferior vascular arcade in the posterior pole fundus of the left eye (Figure 2C). Goldmann periphery showed narrowing-down of the upper central visual field in both eyes (Figure 2E and F).
case_images: Magnetic resonance imaging 4 months after the initial visit. The pituitary stalk and the pituitary gland have decreased in size (arrows) on T2-weighted sagittal (A) and coronal (B) images. Note persistent enhancement with gadolinium diethylenetriamine pentaacetic acid (DTPA) contrast in the whole pituitary gland and the stalk (arrows) on T1-weighted sagittal (C) and coronal (D) images, as the same as the images 4 months previously (Figure 1D and E).
case_images: 10.1177_23247096231186046-fig3.jpg
case_images: PMC10338657_01_10.1177_23247096231186046-fig3.jpg
case_images: fig3-23247096231186046
case_images: Head magnetic resonance imaging showed that the pituitary gland and stalk decreased in size (Figure 3A and B), but showed persistent contrast enhancement (Figure 3C and D) as the same as the images 2 months previously (Figure 1D and F).