Liver Abscess as the Complication of Ventriculoperitoneal Shunt Associated with Skin Injury

A 50-year-old male who had undergone ventriculoperitoneal shunt for hydrocephalus following acoustic neurinoma surgery 18 months earlier presented with progressive fatigue and loss of appetite. Three months prior to visiting our hospital, he fell off his bicycle and sustained a skin laceration just above the tube on the right clavicle. He exhibited tenderness in the right upper quadrant but no other neurological symptoms. A contrast-enhanced abdominal computed tomography scan revealed a large well-defined lesion in the right lobe of the liver, with the shunt tube having migrated into the lesion. Ultrasound-guided percutaneous drainage was performed, resulting in a diagnosis of liver abscess. Culture of the drainage fluid confirmed the presence of methicillin-resistant Staphylococcus aureus, and vancomycin therapy was initiated. Later, an increased cell count, predominantly neutrophils, was observed in his cerebrospinal fluid. We then removed the entire shunt system and administered linezolid, after which the cerebrospinal fluid cell count normalized within almost one month. Liver abscesses as a complication of ventriculoperitoneal shunt are rare, with only 11 cases reported in the previous literature. This is possibly the first case associated with traumatic skin injury occurring long after ventriculoperitoneal shunt placement. With proper management of the shunt tube and administration of the appropriate antibiotic treatment, a favorable prognosis can be expected.