Liver abscess caused by an infected ventriculoperitoneal shunt

Meng Chuan Shen, S. S J Lee, Yao Shen Chen, Muh Yong Yen, Yung Ching Liu

Research output: Contribution to journalArticle

8 Citations (Scopus)

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 absess caused by methicillin-resistant Staphylococcus aureus (MRS), 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 hypoglycorrhacia. 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.

Original languageEnglish
Pages (from-to)113-116
Number of pages4
JournalJournal of the Formosan Medical Association = Taiwan yi zhi
Volume102
Issue number2
Publication statusPublished - Feb 1 2003
Externally publishedYes

Keywords

  • Liver abscess
  • Prosthesis-related infections
  • Staphylococcal infections
  • Ventriculoperitoneal shunt

ASJC Scopus subject areas

  • Medicine(all)

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