A case of bacterial meningitis due to colon perforation of V-P shunt tube in an elderly patient with prolonged high fever after hospitalization for urinary tract infection
An 86-year-old woman who had received a V-P shunt for subarachnoid hemorrhage 23 years previously presented to the emergency room with a chief complaint of fever. The diagnosis on admission was urinary tract infection, and treatment with CMZ was started. Abdominal CT scan on admission revealed that the V-P shunt had penetrated the ascending colon; however, because there were no clinical symptoms or imaging findings suggestive of peritonitis or meningitis, the V-P shunt was not initially considered to be related to the fever. However, since the fever in the 39°C range persisted for a week despite a urine culture showing susceptible Escherichia coli, a spinal fluid examination was performed on the assumption of meningitis caused by the V-P shunt. We found elevated cell counts in the CSF and diagnosed the patient with bacterial meningitis. After shunt removal surgery was performed, the patient quickly recovered from fever. Later, Pseudomonas aeruginosa was detected at the shunt tube and in the CSF, and CFPM was administered continuously. The patient was discharged with good progress.A review of the relevant literature revealed that half of the patients with a V-P shunt penetrating the intestinal tract will pass asymptomatically and are unlikely to develop peritonitis, while half of the patients may develop meningitis. In addition, if there is an artifact in the body, it is always necessary to consider the possibility that it may be the source of infection.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2022 |
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| Erschienen: |
2022 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:59 |
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| Enthalten in: |
Nihon Ronen Igakkai zasshi. Japanese journal of geriatrics - 59(2022), 4 vom: 07., Seite 551-558 |
| Sprache: |
Japanisch |
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| Beteiligte Personen: |
Nakamura, Hironobu [VerfasserIn] |
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| Links: |
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| Themen: |
Case Reports |
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| Anmerkungen: |
Date Completed 15.12.2022 Date Revised 15.12.2022 published: Print Citation Status MEDLINE |
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| doi: |
10.3143/geriatrics.59.551 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM349891087 |
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| 245 | 1 | 2 | |a A case of bacterial meningitis due to colon perforation of V-P shunt tube in an elderly patient with prolonged high fever after hospitalization for urinary tract infection |
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| 500 | |a published: Print | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a An 86-year-old woman who had received a V-P shunt for subarachnoid hemorrhage 23 years previously presented to the emergency room with a chief complaint of fever. The diagnosis on admission was urinary tract infection, and treatment with CMZ was started. Abdominal CT scan on admission revealed that the V-P shunt had penetrated the ascending colon; however, because there were no clinical symptoms or imaging findings suggestive of peritonitis or meningitis, the V-P shunt was not initially considered to be related to the fever. However, since the fever in the 39°C range persisted for a week despite a urine culture showing susceptible Escherichia coli, a spinal fluid examination was performed on the assumption of meningitis caused by the V-P shunt. We found elevated cell counts in the CSF and diagnosed the patient with bacterial meningitis. After shunt removal surgery was performed, the patient quickly recovered from fever. Later, Pseudomonas aeruginosa was detected at the shunt tube and in the CSF, and CFPM was administered continuously. The patient was discharged with good progress.A review of the relevant literature revealed that half of the patients with a V-P shunt penetrating the intestinal tract will pass asymptomatically and are unlikely to develop peritonitis, while half of the patients may develop meningitis. In addition, if there is an artifact in the body, it is always necessary to consider the possibility that it may be the source of infection | ||
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| 650 | 4 | |a Fever | |
| 650 | 4 | |a Intestinal perforation | |
| 650 | 4 | |a Meningitis | |
| 650 | 4 | |a V-P shunt | |
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