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Fungal meningitic hydrocephalus with repeated shunt malfunction

Reiko Kagawa1, Yoshikazu Okada, Kouzo Moritake

  • 1Department of Neurosurgery, Muikaichi Hospital, Kanoashi-gun, Shimane, Japan.

Neurologia Medico-Chirurgica
|January 26, 2008
PubMed

Insights

This case report details a rare, recurrent fungal meningitis caused by Aspergillus, diagnosed 15 years after initial symptoms. Long-term fluconazole and surgical decompression proved effective in managing this chronic infection.

Area of Science:

  • Neurology
  • Infectious Diseases
  • Mycology

Background:

  • Fungal meningitis is a rare but serious infection, particularly in immunocompromised individuals.
  • Chronic or recurrent meningitis presents significant diagnostic and therapeutic challenges.

Observation:

  • A 33-year-old female experienced recurrent meningitis over 15 years with initial negative cultures.
  • Cerebrospinal fluid analysis revealed inflammatory markers consistent with meningitis.
  • Imaging identified hydrocephalus and a spinal cord mass, leading to suspicion of fungal etiology.

Findings:

  • Aspergillus was definitively identified 15 years after symptom onset from a ventriculoatrial shunt.
  • Initial treatment with amphotericin B provided temporary relief.
  • Surgical intervention (foramen magnum decompression) and long-term fluconazole administration were ultimately effective.

Implications:

  • This case highlights the importance of considering fungal meningitis in chronic, relapsing cases, even with initially negative diagnostic tests.
  • Delayed diagnosis of Aspergillus meningitis can occur, necessitating prolonged and multimodal treatment strategies.
  • Effective management requires a combination of antifungal therapy, surgical intervention, and careful monitoring for complications like shunt malfunction.

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