Undiagnosed Cryptococcus gattii meningitis leading to subsequent ventriculoperitoneal shunt infection in a patient with symptoms of normal pressure hydrocephalus: case report and literature review

Abstract

BackgroundCryptococcus gattii is known to be an etiologic agent of human cryptococcosis, particularly in immunocompetent persons. C. gattii infection usually involves the central nervous system, the respiratory tract, or may be disseminated. Here we report an atypical manifestation of C. gattii infection in a patient who had C. gattii meningitis complicating the ventriculoperitoneal (VP) shunt infection and concurrent infected intraabdominal VP shunt pseudocyst.Case presentationA 66-year-old Thai female was initially diagnosed with normal pressure hydrocephalus (NPH) and underwent programmable VP shunt placement. However, she still suffered from recurrent communicating hydrocephalus with in-place VP shunt, and later developed recurrent gait impairment, chronic abdominal pain and abdominal mass. Radiological studies demonstrated recurrent hydrocephalus and a very large intraabdominal VP shunt pseudocyst. C. gattii was isolated from both the cerebrospinal fluid and the pseudocyst aspiration. C. gattii meningitis complicating the VP shunt infection and concurrent infected intraabdominal VP shunt pseudocyst was diagnosed. Prolonged antifungal therapy, removal of the infected VP shunt with subsequent implant of a new shunt provided a good outcome.ConclusionChronic C. gattii meningitis should be aware in a patient presenting with normal pressure hydrocephalus. Under-diagnosed cryptococcal meningitis following VP shunt insertion for treating the hydrocephalus can render a complicated VP shunt infection including infected VP shunt pseudocyst.

Normal Pressure Hydrocephalus Associated with COVID-19 Infection: A Case Report

“…Outcomes in patients with secondary NPH (sNPH) tend to be better than in those with idiopathic NPH (iNPH), with improvement after shunt in 50-70% in sNPH and only 30-50% in iNPH [9]. Some speci c infectious diseases have also been reported as possible etiologies for NPH, including Lyme disease [10], neurosyphilis [11] and cryptococcosis [12], but as far as we know it hasn't been associated with COVID-19 infection. Some mechanisms could explain CNS invasion in COVID19.…”

Normal pressure hydrocephalus secondary to Lyme disease, a case report and review of seven reported cases

“…sNPH caused by neuroborreliosis is believed to be triggered in arachnoid granulate in the subarachnoidal spaces when the chronic infection presents itself in the form of infiltration of the spirochete, and when inflammatory cells and proteins disturb the CSF absorption [ 5 ]. It falls in the same category as NPH by neurosyphilis [ 10 ] and by cryptococcus infection [ 11 ]. Infectious sNPH is believed to develop within a time span from 10 days to up to 6 months after the infection [ 9 ].…”