Primary Bacterial Ventriculitis caused by Staphylococcus warneri

A 51-year-old female patient was evaluated at Atatürk University Hospital for headache and drowsiness. She had no fever, neck stiffness, or motor deficits. A hyperdense area in the right lateral ventricle was observed on brain computed tomography (CT) (Figure 1). More prominent bilateral hyperintense areas adjacent to the right lateral ventricle were observed in the FLAIR sequence on magnetic resonance imaging (MRI). Based on the imaging, a diagnosis of ventriculitis was proposed (Figure 2). A lumbar puncture (LP) was performed. Cerebrospinal fluid (CSF) demonstrated a xanthochromic appearance. The glycoprotein level of the CSF was 60 mg/dL, and the glucose level was 62 mg/dL (simultaneous blood glucose level was 105 mg/dL). Direct examination revealed 4 lymphocytes. Ceftriaxone (1 g, 2 × 2) was initiated. Staphylococcus warneri was detected in the CSF. The patient had an infected, ulcerated, and hyperpigmented wound in the left nose-cheek region, which was said to have been present for 2-3 years (Figure 3). The histopathological examination was compatible with squamous cell carcinoma. No other source of infection was found. The cause of ventriculitis was thought to be an infected wound and the complex lymphatic drainage of the head region. The patient did not undergo a repeat LP. Clinical improvement was evident after 21 days of antibiotic treatment. Staphylococcus warneri constitutes <1% of the staphylococcal flora of the skin¹. Although ventriculitis mostly develops due to external ventricular drains, cases of primary bacterial ventriculitis have rarely been reported². Importantly, Staphylococcus warneri rarely causes primary ventriculitis.

FIGURE 1:
CT of the brain showing a hyperdense area is observed in the right lateral ventricle.

FIGURE 2:
MRI of the brain showing more prominent bilaterally hyperintense areas adjacent to the right lateral ventricle in the FLAIR sequence. This was evaluated as being compatible with ventriculitis.

FIGURE 3:
Clinical photograph showing an ulcerated and hyperpigmented wound with discharge in the left nose-cheek region.

ACKNOWLEDGMENTS

None.

REFERENCES

• ¹
  Kloos WE. Natural Populations of the Genus Staphylococcus. Annu Rev Microbiol. 1980;34:559-92. Available from: https://doi.org/10.1146/annurev.mi.34.100180.003015
  » https://doi.org/10.1146/annurev.mi.34.100180.003015
• ²
  Lesourd A, Magne N, Soares A, Lemaitre C, Taha MK, Gueit I, et al. Primary bacterial ventriculitis in adults, an emergent diagnosis challenge: report of a meningoccal case and review of the literature. BMC Infect Dis. 2018;18:226. Available from: https://doi.org/10.1186/s12879-018-3119-4
  » https://doi.org/10.1186/s12879-018-3119-4

• Financial Support: No financial support was used in this study.

• ERRATUM

  Revista da Sociedade Brasileira de Medicina Tropical/Journal of the Brazilian Society of Tropical Medicine
  Title: Primary Bacterial Ventriculitis caused by Staphylococcus warneri
  56: (e0631-2022) 2023 - Page: 1/3 - doi: https://doi.org/10.1590/0037-8682-0631-2022
  FIGURE 2:
  

  
  
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Publication Dates

• Publication in this collection
  06 Mar 2023
• Date of issue
  2023

History

• Received
  02 Jan 2023
• Accepted
  25 Jan 2023