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Published on: June 4, 2012

Conspicuous endoscopic appearance of ventriculitis caused by coagulase-negative staphylococci

Chih-Wei Chang1, Goro Nagashima, Tsukasa Fujimoto

  • 1Department of Neurosurgery, Fujigaoka Hospital, Showa University, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa 227-8501, Japan.

Journal of Infection and Chemotherapy : Official Journal of the Japan Society of Chemotherapy
|June 27, 2007
PubMed

Insights

Neuroendoscopy revealed granular ependymitis in a rare case of bacterial ventriculitis. This rare finding, associated with coagulase-negative staphylococci, was successfully treated with endoscopic rinsing and antimicrobial therapy.

Area of Science:

  • Neuroscience
  • Infectious Diseases
  • Neurosurgery

Background:

  • Ventriculitis, an inflammation of the brain's ventricles, is infrequently reported, with limited macroscopic descriptions available, primarily from autopsy studies.
  • This case involves a 44-year-old male with hydrocephalus secondary to subarachnoid hemorrhage, who developed a shunt infection.

Observation:

  • The patient presented with altered consciousness due to progressive hydrocephalus and a retrograde shunt infection caused by coagulase-negative staphylococci.
  • Cerebrospinal fluid (CSF) analysis confirmed the infection, which was resistant to multiple antibiotics.
  • Neuroendoscopy revealed multiple small, yellowish microgranulations (<1 mm) in the lateral and third ventricles, consistent with granular ependymitis.

Findings:

  • Endoscopic rinsing combined with intensive antimicrobial treatment led to the resolution of bacterial ventriculitis.
  • The microgranulations observed during endoscopy, though their exact nature (bacterial colonies or inflammatory response) remains uncertain, were associated with a successfully treated infection.

Implications:

  • This case provides rare endoscopic visualization of bacterial ventriculitis, offering insights into its macroscopic appearance.
  • The successful treatment highlights the potential role of neuroendoscopy in managing complex shunt infections.
  • Long-term follow-up confirmed the absence of recurrence, underscoring the efficacy of the combined therapeutic approach.

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