Recurrent Shoulder Tip Pain After Ventriculoperitoneal Shunt Placement Associated with Infectious Peritonitis with <i>Propionibacterium acnes</i>; A Case Report and Review of the Literature

Abstract

Ventriculoperitoneal (VP) shunt placement is commonly performed for the treatment of hydrocephalus, and several complications of this procedure are well known. Radiating shoulder tip pain after VP shunt placement has been reported as an unusual complication in a few cases, associated with dislocation of the peritoneal catheter. We described the case of a 9-year-old girl who presented with recurrent radiating shoulder tip pain after VP shunt placement. The pain recurred after peritoneal catheter repositioning because of peritoneal inflammation and adhesion due to peritonitis with Propionibacterium acnes (P. acnes). This bacterium was isolated using 16S ribosomal RNA gene polymerase chain reaction (16S rRNA gene PCR), and anaerobic and prolonged culture tests. After antibacterial treatment, ventriculoarterial (VA) shunt placement was successfully performed. Hemidiaphragm irritation by the peritoneal catheter leads to radiating shoulder tip pain, and peritoneal inflammation and adhesion caused by infectious peritonitis may cause recurrence of this despite catheter repositioning. Clinicians should be aware of shoulder pain as a complication of VP shunt placement, and should consider VA shunt placement as an alternative treatment if this symptom recurs after catheter repositioning. Furthermore, 16S rRNA gene PCR and anaerobic and prolonged culture tests should be considered to detect P. acnes infection.

A Janus-Faced Bacterium: Host-Beneficial and -Detrimental Roles of Cutibacterium acnes

“…Current studies that report strain comparisons need to be handled with caution; much can depend on the individual, selected strains (that can have slight differences, e.g., in growth behavior and oxygen sensitivity) as well as on the method/model that is applied to evaluate bacterial pathogenicity or host-interaction. Dréno et al, 2018Dréno et al, , 2020Platsidaki and Dessinioti, 2018;Brüggemann, 2019;McLaughlin et al, 2019 Lomholt andKilian, 2010;McDowell et al, 2011;Fitz-Gibbon et al, 2013;Dagnelie et al, 2018 Portillo et al, 2013;Achermann et al, 2014;Aubin et al, 2014;Gharamti and Kanafani, 2017;Boisrenoult, 2018;Renz et al, 2018Zeller et al, 2007Aubin et al, 2017;Banzon et al, 2017;Lavergne et al, 2017;Liew-Littorin et al, 2019;Lee et al, 2020;Suzuki et al, 2020a Cohen et al, 2005;Alexeyev et al, 2007;Fassi Fehri et al, 2011;Shinohara et al, 2013;Bae et al, 2014;Davidsson et al, 2016Davidsson et al, , 2017 *A, B, C: strong, medium, and weak evidence, respectively, based on the existing scientific literature. **CD, culture-dependent; CI, culture-independent; IHC/IF, immunohistochemistry/immunofluorescence.…”

“…Clinical symptoms in shunt infections are non-specific; the absence of fever is common (Aubin et al, 2014). PCR has been described as effective method to detect C. acnes in CSF infections (Suzuki et al, 2020a), although this method might be too sensitive.…”

Referred Shoulder Pain Due to the Positioning of the Ventriculoperitoneal Shunt: A Case Report and Literature Review of an Unusual Complication

“…Propionibacterium acnes was later identified. Eventually, she underwent an operation for external drainage and received adequate antibiotic therapy, leading to the placement of a ventriculoarterial shunt with no recurrence of her symptoms [ 9 ].…”