Table 1 Summary of case reports of cryptococcal meningitis complicating ventriculoperitoneal (VP) shunt infection with or without concurrent infected intraabdominal VP shunt pseudocyst
Case Author (year) | Age (yrs)/ Sex | Underlying conditions | Onseta (mo-yrs) | Clinical manifestations | Findings | Cryptococcus species | Managements | Outcomes |
|---|---|---|---|---|---|---|---|---|
1–3 Mangham et al. [9] (1983) | 22/M | – | 1 yr | Rapidly declined consciousness with frontal headache | CT brain: hydrocephalus Brain necropsy: basilar meningitis with yeast like organisms seen | C. neoformans | ABD, 5-FC, shunt removal | Dead |
58/M | – | 9 mo | Progressive headache and memory deficit | CT brain: hydrocephalus Intact shunt function | C. neoformans | ABD, 5-FC, shunt removal | Recovery | |
55/M | CLD, DM, NPH | 4 mo | Memory deficit and gait difficulty | CT brain: hydrocephalus Brain necropsy: fibrous and thickening leptomeninges with yeast like organisms seen | C. neoformans | ABD, 5-FC | Dead | |
4 Crum-Cianflone et al. [10] (2008) | 34/M | HIV, TB meningitis | 1Â yr | Abdominal distention | CT abdomen: intraabdominal CSF VP shunt pseudocyst, sized 26Â cm Cyst fluid CRAG titers of 1:64 | C. neoformans | LAB, 5-FC then oral FLU and 5-FC, cyst aspiration and shunt removal | Recovery |
5 Viereck et al. [11] (2014) | 65/M | NPH | 20Â yrs | Difficult ambulation and confusion | Intact shunt function Radiographic findings: no data | C. neoformans | ABD, 5-FC, shunt removal and reimplant | Recovery |
6 Lee et al. [12] (2016) | 80/M | NPH | 10Â yrs | Abdominal pain and diarrhea | CT abdomen: large intraperitoneal CSF VP shunt pseudocyst | C. neoformans | ABD, 5-FC and shunt removal | Recovery, no residual pseudocyst |
7 Foong et al. [13] (2016) | 52/M | NPH | 1Â yr | Fever, lethargy, confusion | CT brain: hydrocephalus with possible shunt malfunction | C. neoformans | LAB, 5-FC then oral FLU, shunt removal and reimplant | Recovery |
8 Genebat et al. [14] (2017) | 36/F | HIV, TB meningitis | 1Â yr | Abdominal mass | CT abdomen: subcutaneous CSF VP shunt pseudocyst, sized 7Â cm | C. neoformans | LAB, 5-FC then oral FLU, and shunt removal | Recovery, no residual pseudocyst |
9 The present case | 66/F | HT | 2 yrs | Gait difficulty, dizziness, headache, abdominal mass | CT brain: hydrocephalsCT abdomen: intraabdominal CSF VP shunt pseudocyst, sized 15 cm Cyst fluid CRAG titers of > 1:1024 | C. gattii | ABD, FLU then oral FLU, shunt removal and reimplant | Recovery, no residual pseudocyst |