Abiotrophia defectiva meningitis following ventriculoperitoneal shunt repair: Case report and literature review

Abstract

Abiotrophia defectiva is an uncommon and potentially severe cause of bacterial meningitis that can be seen in the setting of neurosurgical procedures. We describe here a case of A. defectiva meningitis in a patient with VP shunt revision. The patient is a 59-year-old female with VP shunt placed several years prior in the setting of normal pressure hydrocephalus. She underwent successful shunt repair following worsening gait abnormalities. On post-operative day 8 she was brought to the emergency room with fevers, photophobia and altered mentation. CSF cultures returned positive for A. defectiva and she was treated with intravenous vancomycin. Due to the presence of retained hardware she was discharged on chronic suppressive therapy with oral amoxicillin. This case illustrates A. defectiva as a cause of bacterial meningitis following neurosurgical intervention. It is important to consider this fastidious organism and tailor antimicrobial therapy appropriately to prevent significant morbidity and mortality. As was the case with our patient, suppressive therapy may be warranted in setting of retained hardware.