Fungal Meningitic Hydrocephalus With Repeated Shunt Malfunction -Case Report-

Abstract

A 33-year-old female presented with a rare case of fungal meningitis caused by Aspergillus detected for the first time at 15 years after onset. The meningitis repeatedly occurred over a period of 15 years. On admission, cerebrospinal fluid examination found cell count 1340/high-power field, protein 158 mg/dl, and sugar 8 mg/dl, indicating meningitis, although no bacterial or fungal species were detected. Cerebral computed tomography demonstrated hydrocephalus and cervical computed tomography demonstrated a mass lesion on the ventral side of the spinal cord from C4 to C6. Fungal meningitis was suspected and treated with amphotericin B. Her symptoms improved and she was eventually discharged. She was readmitted for recurrence of meningitis and hydrocephalus 2 months later. Amphotericin B was administered and a ventriculoperitoneal (VP) shunt was placed. Shunt malfunction recurred seven times. Aspergillus was detected for the first time from the atrium side of the ventriculoatrial shunt tube at 15 years after onset. Fluconazole was administered. She had narrowing of the cisterna magna, and underwent foramen magnum decompression. The VP shunt was finally reconstructed. Fluconazole administration was continued. Combination of foramen magnum decompression and long-term administration of fluconazole was effective in this case.

Aspergillus meningitis: A rare clinical manifestation of central nervous system aspergillosis. Case report and review of 92 cases

“…5,6,36,50e68 In patients with a diagnosis of meningitis fever and headache were the most common presenting symptoms (78.8%) followed by neck stiffness in 28.2% (24/85). 3e6,9e76 3,6,10,12,13,15,22,23,25e27,29,32,33,39,44,45,47,52,54,56,58,63,76,78,79 PR as opposed to immunocompromised individuals (39%). 5,9,28,29,34,36,40,42,46,48,55,59,74 This difference might be explained by a more aggressive and acute course of the disease observed in immunosuppressed hosts.…”

Immunocompetent isolated cerebral mucormycosis presenting with obstructive hydrocephalus: illustrative case

“…Regarding obstructive hydrocephalus secondary to infection, the majority of the literature describes a bacterial etiology including gram-negative rods 32 or tuberculosis basal meningitis 33 , 34 or is opaquely nonspecific with regard to the nuances of fungal infectious hydrocephalus. 5 , 10 Single case reports of obstructive hydrocephalus secondary to other fungal infections in both immunocompromised 35 and immunocompetent 36 adult patients have been described, but these too were in the setting of clear infectious sequelae and focal obstructive pathology on MRI.…”

Central nervous system Aspergillus infection after epidural analgesia: diagnosis, therapeutic challenges, and literature review

“…CNS aspergillosis often presents with symptoms of altered mental status, a focal neurological deficit, seizure, persistent headache, or rarely meningeal signs (Gordon et al, 1976; Torre-Cisneros et al, 1993; Figueiredo et al, 2003; Kagawa et al, 2008). Both rapid and slow clinical progressions have been described (Gordon et al, 1976; Kaufman et al, 1976; Moling et al, 2002; Gunaratne et al, 2007; Azarpira et al, 2008).…”