Successful treatment of severe ventriculitis by continuous intraventricular irrigation in an elderly patient

Abstract

  Pyogenic ventriculitis is a rare but severe cerebral infection. We report a case of severe ventriculitis cured with continuous intraventricular irrigation (CIVI) in an elderly patient. An originally healthy 88‒year‒old male presented with fever, seizure, and consciousness disturbance. Computed tomography of the brain revealed hydrocephalus and ventriculitis, and a systemic examination revealed a pyogenic liver abscess. We performed emergency liver abscess drainage and external ventricular drainage; the drained ventricular fluid was suppurative pus. These findings led us to make a diagnosis of secondary pyogenic ventriculitis following liver abscess. We performed CIVI until postoperative day 8. Culture tests of blood and cerebrospinal fluid samples revealed Klebsiella pneumoniae, and ceftriaxone was administered for 6 weeks. The antibacterial agent had favorable effects against the infection, and a ventriculo‒peritoneal shunt was performed 2 months later. These treatments improved the patient's initial condition. In carefully selected cases, CIVI followed by adequate antibiotic therapy can be effective against severe ventriculitis even in elderly patients.