title: Conspicuous endoscopic appearance of ventriculitis caused by coagulase-negative staphylococci.
abstract: To date, reports about the macroscopic appearance of ventriculitis have been rare, consisting only of a few autopsy cases. A patient in our hospital had ventriculitis caused by coagulase-negative staphylococci, and under neuroendoscopy we obtained clear findings of granular ependymitis. A 44-year-old man was admitted for disturbance of consciousness caused by progressive hydrocephalus. He had experienced subarachnoid hemorrhage (SAH) from a left vertebral dissecting aneurysm, and had subsequently received a ventriculoperitoneal shunt against post-SAH hydrocephalus. After admission, he was found to have retrograde shunt infection from peritonitis caused by cholecystitis. Coagulase-negative staphylococci were detected in cerebrospinal fluid (CSF), and the infection persisted even with intrathecal administration of gentamycin, and intravenous administration of vancomycin and arbekacin. Endoscopic rinsing was performed, and multiple small yellowish microgranulations, less than 1 mm in diameter, were observed in the lateral ventricles and the third ventricle. Rinsing of the CSF after intensive antimicrobial treatment resulted in a cure. Because there have been no reports of endoscopic observations of bacterial ventriculitis, we were unable to be certain about the origin or significance of the microgranulations. However, whether or not the microgranulations were bacterial colonies, infection did not recur during a 2-year follow-up period.
authors.affiliation: Department of Neurosurgery, Fujigaoka Hospital, Showa University, 1-30 Fujigaoka, Aoba-ku, Yokohama-shi, Kanagawa 227-8501, Japan.
authors.forename: Chih-Wei
authors.initials: CW
authors.lastname: Chang
authors.forename: Goro
authors.initials: G
authors.lastname: Nagashima
authors.forename: Tsukasa
authors.initials: T
authors.lastname: Fujimoto
authors.forename: Ryuta
authors.initials: R
authors.lastname: Suzuki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Itokawa
authors.forename: Shu
authors.initials: S
authors.lastname: Endoh
authors.forename: Masayuki
authors.initials: M
authors.lastname: Noda
authors.forename: Muneo
authors.initials: M
authors.lastname: Okuda
mesh_terms: D000328:Adult; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D002552:Cerebral Ventricles / Q000382:microbiology* / Q000473:pathology; D002764:Cholecystitis / Q000150:complications; D004660:Encephalitis / Q000175:diagnosis / Q000382:microbiology / Q000473:pathology; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests; D044583:Neuroendoscopy; D010538:Peritonitis / Q000150:complications; D013203:Staphylococcal Infections / Q000134:cerebrospinal fluid* / Q000175:diagnosis / Q000188:drug therapy / Q000473:pathology*; D013210:Staphylococcus / Q000145:classification / Q000187:drug effects / Q000201:enzymology / Q000472:pathogenicity; D013345:Subarachnoid Hemorrhage / Q000628:therapy; D017287:Ventriculoperitoneal Shunt / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents