Description

A 78-year-old woman with the history of spinal stenosis presented to our emergency room by ambulance with the acute onset of back pain and mild altered mental status. On examination, there was knock pain over the right costovertebral angle. Urinalysis showed pyuria and bacteriuria. She was admitted with a diagnosis of urinary tract infection. Empiric treatment was started with intravenous ceftriaxone. An initial CT scan showed bilateral ventricular enlargement (figure 1). Because she had prolonged disturbance of the consciousness, a lumbar puncture was tried with suspected meningeal dissemination; it was failed due to her difficulty in appropriate positioning for the procedure. Surprisingly, repeated CT scan on day 3 after admission showed increased ventricular densities with fluid-debris levels in the dependent portions of the bilateral lateral ventricles (figure 2). A diagnosis of pyogenic ventriculitis complicated by urinary tract infection was considered and emergent bilateral ventricular drainage was performed with good clinical improvement. Cultures of urine, blood and ventricle-drained pus all grew Escherichia coli with the same antibiogram profiles including susceptibility to ceftriaxone in the drug sensitivity test. Pyogenic ventriculitis is rare but can be a serious complication from sepsis including urosepsis.1 ,2 Urgent diagnosis and neurosurgical drainage is mandatory for preventing neurological morbidity from this important central nervous system complication from any types of sepsis.

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Figure 1

Brain CT scan without contrast enhancement on the day of admission.

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Figure 2

Brain CT scan without contrast enhancement on day 3 after admission.