Cryptococcal Infection of the Ventriculoperitoneal Shunt in an Immunocompetent XXXX .

@entity1 @entity2176 @entity1276 @entity2379 @entity1330 @entity1327 @entity6944 @entity4895 @entity281 @entity413
BACKGROUND Ventriculoperitoneal shunting is an effective treatment for @entity1276 . @entity281 is a common complication. @entity1327 as an implicated organism is rare. In this report, we describe a @entity1 with cryptococcal @entity281 . CASE REPORT A 52-year-old male with normal pressure @entity1276 , status post implantation of VPS one year prior to the presentation; who was admitted with a fever, lethargy and confusion for three days. He was treated empirically with intravenous @entity6944 and @entity2176 for @entity281 . The CSF analysis from both the lumbar puncture and the VPS was significant for a low white blood count, low @entity413 and high protein. Other work-up including India ink and cryptococcal antigen was unrevealing. He remained febrile despite antibiotic treatment for 5 days. The CSF from the shunt was sent for analysis again and it demonstrated similar results from the prior study, but the culture was now positive for @entity1327 . The @entity1 was started on oral @entity4895 and intravenous liposomal @entity2379 . The VPS was removed and an externalized ventricular catheter was placed. The @entity1 showed rapid resolution of the symptoms. CONCLUSIONS To date, there was a total of nine reported cases of cryptococcal @entity281 upon review of the literature. Our presenting case and the literature review highlight the difficulties in making an accurate diagnosis of cryptococcal @entity281 . There were case reports of false negative cryptococcal antigen tests with culture proven @entity1330 . The CSF culture from the shunt remains a mainstay for identifying cryptococcal @entity281 . @entity281 are rare and early diagnosis and treatment is essential for @entity1 management which involves shunt replacement with concomitant administration of intravenous antifungal medication. High clinical suspicion is crucial and shunt culture preferably from the valve is recommended.
