Abstract
Introduction: Allergic reaction to shunt material is rarely encountered. We report a case of hypersensitivity to silicone-based shunt material that did not subside with corticosteroid which required shunt removal.Case presentation: A 5 years old child with spastic quadriplegic cerebral palsy was brought to our ER due to loss of consciousness. Physical examination revealed anisocoria of the pupils (2 mm / 7 mm) and Glasgow Coma Scale score of E2VxM3. Head computed tomography (CT) scan showed a fluid collection in the frontotemporal region and the appearance of schizencephaly.Conclusion: Allergic reaction to silicone in ventriculoperitoneal shunt material is extremely rare. Polyurethane-based tubes are usually used as a substitution for silicone tubes. However, these tubes were not available and were not covered by insurance in Indonesia. Ventriculostomy is another option for selected cases.Keywords: schizencephaly, silicone hypersensitivity, ventriculoperitoneal shunt
Highlights
Allergic reaction to shunt material is rarely encountered
Gower et al.[1] through an electron microscope found that silicone allergy might cause shunt malfunctions which could lead to breast and joint implant complications
In 1992, Goldblum et al.[3] used ELISA to examine two patients with acute reactions to ventriculoperitoneal shunts and revealed that there were increases in serum IgG, which indicated that the two patients had immune-mediated reactions
Summary
Allergic reaction to shunt material is rarely encountered. In 1989, Snow and Kossovsky[2] revealed that three patients experienced several eosinophils and giant cells due to exaggerated responses to the shunt hardware. In 1992, Goldblum et al.[3] used ELISA to examine two patients with acute reactions to ventriculoperitoneal shunts and revealed that there were increases in serum IgG, which indicated that the two patients had immune-mediated reactions. We aimed to report a hypersensitivity case to silicone-based shunt material that did not subside with corticosteroid which required shunt removal. The patient experienced improvement within 2 days to GCS of E4VxM6 and was discharged 5 days postoperatively. The patient was followed up for a week and the allergic reaction did not subside. The patient was referred to another hospital for shunt removal and further management. The patient was followed up in two months on an outpatient basis and had no residual symptoms
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