title: Cryptococcal Infection of the Ventriculoperitoneal Shunt in an HIV-Infected Patient with an Excellent Immunovirologic Status.
abstract: BACKGROUND
  Cryptococcus spp. is a rare cause of ventriculoperitoneal shunt (VPS) infection, with a variable clinical presentation. Diagnosis and treatment of this entity are challenging.
  
  
  METHODS
  A cryptococcal VPS infection occurred in a human immunodeficiency virus-infected patient with an excellent immunovirologic status, with an abdominal mass as the only clinical sign at presentation. Microbiologic diagnosis was confirmed when Cryptococcus neoformans was isolated in 4 cerebrospinal fluid samples on different days. The patient was treated with dual antifungal therapy (liposomal amphotericin B plus flucytosine). The VPS was initially externalized and then removed. At 12-month follow-up, the patient remained asymptomatic, and no replacement VPS was required.
  
  
  CONCLUSIONS
  This is the first reported case of cryptococcal VPS infection in a patient with human immunodeficiency virus infection. Clinical outcome was excellent after dual antifungal therapy plus device withdrawal. Diagnosis and treatment of this entity remain a challenge for clinicians.
authors.affiliation: Emergency Department, Virgen del Rocío University Hospital, Seville, Spain; Immunovirology Laboratory, Instituto de Biomedicina de Sevilla, Virgen del Rocío University Hospital/Centro Superior de Investigaciones Científicas/University of Seville, Seville, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Genebat
authors.affiliation: Neurosurgery Service, Virgen del Rocío University Hospital, Seville, Spain.
authors.forename: María J
authors.initials: MJ
authors.lastname: Mayorga-Buiza
authors.affiliation: University of Seville/Spanish National Research Council, Seville, Spain.
authors.forename: Esperanza
authors.initials: E
authors.lastname: Castillo-Ojeda
authors.affiliation: Neurosurgery Service, Virgen del Rocío University Hospital, Seville, Spain; Instituto de Biomedicina de Sevilla, Virgen del Rocío University Hospital/Centro Superior de Investigaciones Científicas/University of Seville, Seville, Spain.
authors.forename: Mónica
authors.initials: M
authors.lastname: Rivero-Garvía
authors.affiliation: Neurosurgery Service, Virgen del Rocío University Hospital, Seville, Spain; Instituto de Biomedicina de Sevilla, Virgen del Rocío University Hospital/Centro Superior de Investigaciones Científicas/University of Seville, Seville, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Márquez-Rivas
authors.affiliation: Infectious Diseases, Microbiology and Preventive Medicine Unit, Virgen del Rocío University Hospital, Seville, Spain; University of Seville/Spanish National Research Council, Seville, Spain. Electronic address: mej-mejias@telefonica.net.
authors.forename: Manuel E
authors.initials: ME
authors.lastname: Jiménez-Mejías
mesh_terms: D018784:Abdominal Abscess / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D000328:Adult; D000666:Amphotericin B / Q000627:therapeutic use; D000935:Antifungal Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D055499:Catheter-Related Infections / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D020878:Device Removal; D005437:Flucytosine / Q000627:therapeutic use; D015658:HIV Infections / Q000150:complications / Q000188:drug therapy*; D006801:Humans; D008297:Male; D016919:Meningitis, Cryptococcal / Q000150:complications / Q000175:diagnosis* / Q000628:therapy; D017287:Ventriculoperitoneal Shunt
chemical_list: D000935:Antifungal Agents; C068538:liposomal amphotericin B; D000666:Amphotericin B; D005437:Flucytosine
keywords: Cryptococcus; HIV; Ventriculoperitoneal shunt