Intra-Abdominal Ventriculoperitoneal Shunt Abscess from Streptococcus Pyogenes after Pharyngitis with Scarlet Fever: Case Report and Review of the Literature

Abstract

CitationChen SH, Monaco EA 3 rd . Intra-abdominal ventriculoperitoneal shunt abscess from Streptococcus pyogenes after pharyngitis with scarlet fever: Case report and review of the literature. Neuro Open J. 2014; 1(1): 27-30. doi: 10.17140/NOJ-1-107rd . This is an open access article distributed under the Creative Commons Attribution 4.0 International License (CC BY 4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. However, Streptococcus pyogenes (Group A Streptococcus, GAS) as a causative agent appears to be extremely rare. We present an unusual case of a peritoneal shunt infection due to GAS that occurred after pharyngitis with scarlet fever. Case Description: A 31 year-old woman with congenital shunt-dependent hydrocephalus presented with fever, vomiting, and acute abdominal symptoms several weeks after being treated for pharyngitis and scarlet fever. She was found to have a large intra-abdominal peritoneal catheter-associated abscess that grew out GAS. Results: The patient's shunt was externalized at the clavicle and the cerebrospinal fluid (CSF) was sterile. Her peritoneal abscess was treated by percutaneous drainage, laparotomy, and intravenous antibiotics. More permanent CSF diversion was accomplished via ventriculoatrial shunt creation after treatment. She made a full recovery. Conclusion: While shunt infection is an all too common clinical problem, this is the first report of a peritoneal shunt infection caused by GAS after pharyngitis and scarlet fever. Presumably, this infection occurred as a result of haematogenous spread to the shunt site in the abdomen.