SHM Converge Scientific Abstract ePoster Gallery-Hydrocephalus Due to Pyogenic Ventriculitis in West Nile Encephalitis

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This case describes a patient with West Nile virus encephalitis complicated by hydrocephalus and pyogenic ventriculitis. On admission, lumbar puncture showed inflammatory cerebrospinal fluid with neutrophilic pleocytosis, elevated protein, normal glucose, and an opening pressure of 18 cmH2O. Initial testing was negative for West Nile IgG, and the patient was treated empirically with acyclovir, ampicillin, ceftriaxone, azithromycin, and dexamethasone for suspected HSV encephalitis and bacterial meningitis.<br /><br />By hospital day five, serum and CSF West Nile IgM tests returned positive, so antimicrobials were stopped and supportive care continued. The patient then deteriorated neurologically. Repeat MRI on day six showed debris in the bilateral occipital horns, suspicious for pus, along with transependymal edema, consistent with ventriculitis. Broad-spectrum antimicrobials were restarted, including vancomycin and meropenem, and the patient was intubated, transferred to the ICU, and underwent placement of an external ventricular drain (EVD). CSF obtained from the EVD was also positive for West Nile IgM.<br /><br />Subsequently, CSF cultures from the EVD grew Propionibacterium acnes on hospital day 13, supporting superimposed bacterial infection. Despite treatment, the patient continued to worsen and became unable to follow commands. After a prolonged hospitalization with progressive neurologic decline, the patient was transitioned to home hospice on hospital day 38.<br /><br />The case highlights a rare but severe complication of West Nile virus infection: ventriculitis with hydrocephalus, which may require neurosurgical intervention and intensive supportive care.

Asset Subtitle

Carston T. Dammann

Meta Tag

Author List Amr Arar, Carston T. Dammann, Maria Klimenko

Category Clinical Vignettes

Concept Hydrocephalus

Concept Ventriculitis

Concept External Ventricular Drain

Concept Central Nervous System Infection

Concept Cerebrospinal Fluid

Distinguished Non-Finalist

Presenter Organization University of Colorado School of Medicine

Presenting Author Carston T. Dammann

Track Adult

Keywords

West Nile virus

encephalitis

hydrocephalus

pyogenic ventriculitis

cerebrospinal fluid

neutrophilic pleocytosis

external ventricular drain

Propionibacterium acnes

MRI

neurologic decline

Hydrocephalus

Ventriculitis

External Ventricular Drain

Central Nervous System Infection

Cerebrospinal Fluid