A Case of Cerebrospinal Fluid Eosinophilia Associated with Shunt Malfunction

Abstract

A 3-month-old female patient presented with a meningomyelocele at the lumber region associated with congenital hydrocephalus. She underwent ventriculoperitoneal (V-P) shunt surgery using the Sophy system. The shunt system was replaced due to a malformation. Following replacement, the patient presented with cerebrospinal fluid (CSF) eosinophilia at the age of 8 months. The eosinophilic granulocytosis of the CSF improved dramatically following systemic prednisolone administration. CSF eosinophilia without accompanying inflammation or pyrexia in the present case may have resulted from an allergic response to a foreign material such as the silicone tube pressure valve of the Sophy system or the sutures rather than bacterial or fungal infection. Based on our results, we believe that some patients may experience CSF eosinophilia following postoperative V-P shunt due to an allergic reaction to the shunt equipment. Prompt steroid treatment can produce spontaneous regression in such cases.

Foreign Body Granuloma Secondary to Ventriculo-Peritoneal Shunt: A Rare Scenario with a New Insight

“…Persistent CSF eosinophilia is reported in the majority of cases, suggesting a silicone allergy [6,7,8,9,10,11,12,13]. Furthermore, studies have attempted to quantify the allergic response to silicone shunts such as the report by VandeVord et al [13] in 2004.…”

“…An abnormal reaction to shunt components has become rare since the introduction of silicone shunts in 1955 by Pudenz et al [5]. However, CSF eosinophilia and allergic responses to silicone shunts, although poorly understood, are being increasingly reported within the literature [6,7,8,9,10,11,12,13]. …”

Cerebrospinal Fluid Shunting Complications in Children

“…Repeated, short-interval, ventricular catheter obstruction should also raise suspicion for an allergic response, a diagnosis strongly supported by CSF eosinophilia in the context of sterile cultures [67, 68]. Although the PDMS catheter material is the most commonly implicated allergen [65, 69], some have even posited that the ethylene oxide used to sterilize many commercialized shunts may incite an immune response [70] . In cases of suspected shunt hardware allergy, exchanging the PDMS catheter for a polyurethane or “extracted” PDMS catheter, which has been through a series of solvents to extract any unpolymerized silicone oil and polymerization catalysts, may alleviate the problem [65].…”

Epidemiology, Prevention and Management of Ventriculoperitoneal Shunt Infections in Children

“…It has been assumed that staphylococci trigger the activation of eosinophils and their migration into CSF. Another possible cause of liquor eosinophilia is intolerance to or allergy against shunt material, the shunt system’s antimicrobial impregnation or residuals of ethylene dioxide subsequent to sterilization [56,57,58]. …”