The timeline for the presented case.
| Dates | Relevant past medical history and interventions | ||
|---|---|---|---|
| A past history of communicating hydrocephalus resulting from meningitis had undergone VPS 10 years before admission to the hospital. This first shunt was placed in a different hospital with unknown shunt type. The peritoneal tube (silicon) was placed via open mini-laparotomy. | |||
| Date | Summaries from Initial and Follow-up Visits | Diagnostic Testing (including dates) | Interventions |
| 2018/8/2 | 5-day fever | • White blood cell count of 11 970/µL and C-reactive protein level of 1.27 mg/dL (2018/8/2) | • Start cefmetazole treatment (2018/8/2) |
| • Computed tomographic (CT) scan of brain revealed increased hydrocephalus (2018/8/2) | • Revision surgery with replacement of reservoir (2018/8/14) | ||
| • The glucose and protein level in the cerebrospinal fluid (CSF) were 21 mg/dl and 556 mg/dl (2018/8/14) | |||
| • The bacterial culture from the intraoperative CSF revealed an infection of oxacillin-sensitive Staphylococcus aureus (2018/8/14) | |||
| 2018/8/15 | Persistent fever | • CT images of the abdomen demonstrated that the peritoneal catheter was retained in the stomach (2018/8/15) | • Start teicoplanin and cefotaxime treatment (2018/8/19) |
| • Panendoscopy confirmed the presence of peritoneal catheter penetrating the stomach (2018/8/17) | • Surgery for the removal of previous VPS following the insertion of the external ventricular drainage. The removal of the peritoneal catheter and gastrorrhaphy were performed through midline open laparotomy by a general surgeon. (2018/8/24) | ||
| • The bacterial cultures of these tubes revealed the infection of Stenotrophomonas and Entercoccus faecium. (2018/8/24) | • Vancomycin and ceftriaxone treatment (2018/8/24~2018/10/9) | ||
| 2018/10/1 | Hydrocephalus without fever | • CSF culture revealed no bacterial growth. (2018/9/24) | The revision of VPS with burr hole type was performed through left frontal horn of lateral ventricle to left abdomen. The peritoneal shunt was inserted via mini-laparotomy. (2018/10/1) |
| • CSF glucose and protein were 55 mg/dl and 36 mg/dl, respectively. (2018/10/1) | |||
| 2018/10/9 | Discharge without fever; shunt was functional | ||
| 2019/11/11 | No fever; shunt was functional | ||