title: Liver abscess caused by an infected ventriculoperitoneal shunt.
abstract: Pyogenic liver abscess in Taiwan is most commonly due to Klebsiella pneumoniae infection in diabetic patients, and less frequently due to biliary tract infections. Liver abscess caused by ventriculoperitoneal (VP) shunt is very rare. We report a case of liver abscess caused by methicillin-resistant Staphylococcus aureus (MRSA), which developed as a complication of an infected VP shunt. A 53-year-old woman, who had shad a VP shunt implanted 3 months previously for hydrocephalus due to intracranial hemorrhage, presented with fever off and on, drowsiness and seizure attacks for 1 week. Computed tomography (CT) of the brain showed only mild right-sided hydrocephalus, and was negative for intracranial hemorrhage and intracranial mass. Analysis of cerebrospinal fluid showed significant pleocytosis and hypoglycorrhachia. CT scan of the abdomen disclosed a huge abscess in the right lobe of the liver. Cultures of both the cerebrospinal fluid and aspirated liver abscess isolated MRSA. The patient was treated with intraventricular and intravenous vancomycin, intravenous teicoplanin and oral rifampicin, followed by oral chloramphenicol and rifampicin. Percutaneous drainage of the liver abscess and externalization of the VP shunt were performed. The liver abscess had resolved almost completely on ultrasonography after 2 weeks of therapy. Liver abscess in patients with a VP shunt should be considered a possible abdominal complication of the VP shunt, and may be caused by unusual pathogens. Diagnosis requires CT scan and direct aspiration and culture of the liver abscess. Treatment requires management of both the liver abscess and the infected shunt.
authors.affiliation: Section of Infectious Diseases, Department of Medicine, Kaohsiung Veterans General Hospital, 386 Da-chung 1st Road, Kaohsiung 813, Taiwan.
authors.forename: Meng-Chuan
authors.initials: MC
authors.lastname: Shen
authors.forename: Susan Shin-Jung
authors.initials: SS
authors.lastname: Lee
authors.forename: Yao-Shen
authors.initials: YS
authors.lastname: Chen
authors.forename: Muh-Yong
authors.initials: MY
authors.lastname: Yen
authors.forename: Yung-Ching
authors.initials: YC
authors.lastname: Liu
mesh_terms: D005260:Female; D006801:Humans; D008100:Liver Abscess / Q000188:drug therapy / Q000382:microbiology*; D016106:Methicillin Resistance; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000188:drug therapy; D013211:Staphylococcus aureus; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*