Primary pyogenic ventriculitis due to Streptococcus dysgalactiae treated with intralumbar vancomycin administration:...

Intrathecal antibiotics are occasionally employed in the management of central nervous system infections; however, standard treatment regimens have not been clearly established, particularly for primary pyogenic ventriculitis in patients without an intraventricular drain. We report the first documented case of successful intralumbar administration of vancomycin, in combination with systemic antibiotics, for the treatment of primary pyogenic ventriculitis caused by Streptococcus dysgalactiae in a 65-year-old Japaneses woman. Despite receiving appropriate systemic antibiotic therapy, her level of consciousness showed no significant improvement, indicating that systemic therapy alone was insufficient to control the infection. Due to her advanced breast cancer, poor general condition, and limited prognosis, the neurosurgical team deemed intraventricular drainage inappropriate. As an alternative, intralumbar vancomycin therapy was initiated. Serial intrathecal vancomycin concentrations were measured during intralumbar vancomycin therapy, providing valuable pharmacokinetic data. This case highlights that intralumbar vancomycin may represent a feasible therapeutic alternative when systemic antibiotic therapy alone is insufficient. Further studies are warranted to elucidate the pharmacokinetics, efficacy, and safety of this therapeutic approach.