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Cryptococcal peritonitis complicating a ventriculoperitoneal shunt in unsuspected cryptococcal meningitis
Abstract:
A 34 year old male was hospitalized because of the probability of a posterior fossa lesion that had increased intracranial pressure. A ventriculoperitoneal shunt was implanted, resulting in partial resolution of symptoms. Subsequently Cryptococcus neoformans was cultured from the cerebrospinal fluid and a diagnosis of cryptococcal meningitis was made. Despite amphotericin B therapy, the patient continued to deteriorate and died on the eighty-fifth day of hospitalization. Autopsy demonstrated cryptococcal meningitis and cerebral edema. An unexpected finding was cryptococcal peritonitis, which was not associated with disseminated disease. The case is unique because cryptococcal peritonitis is rare, and the spread of the organism occurred through a ventriculoperitoneal shunt.
Insights
A rare case of cryptococcal meningitis complicated by cryptococcal peritonitis occurred in a patient with a ventriculoperitoneal shunt. The shunt likely facilitated the unusual spread of the fungus.
Area of Science:
- Neurology
- Infectious Diseases
- Medical Mycology
Background:
- Posterior fossa lesions can cause increased intracranial pressure, necessitating interventions like cerebrospinal fluid (CSF) diversion.
- Ventriculoperitoneal shunts are used to manage hydrocephalus but can be a conduit for infection.
Observation:
- A 34-year-old male presented with symptoms of increased intracranial pressure, likely due to a posterior fossa lesion.
- A ventriculoperitoneal shunt was placed, providing temporary symptom relief.
Findings:
- Cerebrospinal fluid cultures revealed *Cryptococcus neoformans*, confirming cryptococcal meningitis.
- Despite amphotericin B treatment, the patient's condition worsened, leading to death.
- Autopsy confirmed cryptococcal meningitis and cerebral edema, with an incidental finding of cryptococcal peritonitis.
Implications:
- This case highlights a rare presentation of cryptococcal meningitis with concurrent cryptococcal peritonitis.
- The ventriculoperitoneal shunt appears to have facilitated the unusual spread of *Cryptococcus neoformans* to the peritoneum.
- This case underscores the potential complications associated with cerebrospinal fluid shunts in the context of fungal infections.