Trapped Below: Abdominal Pseudocysts Associated With Ventriculoperitoneal Shunts in Coccidioidal Meningitis

Area of Science:

• Infectious Diseases
• Neurosurgery
• Medical Complications

Background:

• Ventriculoperitoneal (VP) shunts are crucial for managing hydrocephalus in coccidioidal meningitis (CM).
• Abdominal pseudocysts (APCs) are a rare complication of VP shunt distal catheters, with limited data in CM.
• Understanding APCs in CM is essential for patient management.

Purpose of the Study:

• To investigate the incidence and characteristics of abdominal pseudocysts (APCs) in patients with coccidioidal meningitis (CM)-associated hydrocephalus.
• To describe the clinical presentation, diagnostic findings, and management outcomes of APCs in this population.
• To compare the incidence of APCs in CM with other hydrocephalus etiologies.

Main Methods:

• Retrospective study of 124 patients with CM who underwent VP shunt placement between 2010 and 2024.
• Analysis of patient demographics, clinical presentations, imaging findings, and treatment outcomes.
• Correlation of APC occurrence with active Coccidioides infection status.

Main Results:

• Abdominal pseudocysts (APCs) occurred in 21 patients (17%), a higher incidence than in other hydrocephalus etiologies.
• Most APCs presented with symptoms of shunt malfunction, not abdominal complaints.
• Active Coccidioides infection was present in 71% of patients; imaging showed fluid collections at the distal catheter tip.
• Surgical intervention was common, but recurrent shunt failures were substantial.

Conclusions:

• Abdominal pseudocysts (APCs) are a significant complication of VP shunts in coccidioidal meningitis (CM), occurring more frequently than previously reported.
• APCs in CM often manifest as shunt malfunction, necessitating prompt diagnosis and intervention.
• Further research is needed to elucidate the contributing factors and optimize management strategies for APCs in CM.