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Infective endocarditis as a complication of longstanding ventriculoatrial (VA) shunt: the importance of suspicion and early investigation in patients with VA shunt and pyrexia of unknown origin
  1. Rosa Sun1,
  2. Richard Warwick2,
  3. Stuart Harrisson1 and
  4. Nageswar Bandla3
  1. 1Neurosurgery, Royal Stoke University Hospital, Stoke-on-Trent, Staffordshire, UK
  2. 2Cardiothoracic Surgery, Royal Stoke University Hospital, Stoke-on-Trent, Staffordshire, UK
  3. 3Critical Care, University Hospitals of North Midlands NHS Trust, Stoke-on-Trent, UK
  1. Correspondence to Rosa Sun, Neurosurgery, Royal Stoke Hospital, Stoke on Trent, UK; r.sun1{at}nhs.net

Abstract

Ventriculoatrial (VA) shunts are a method of cerebrospinal fluid diversion, which nowadays are infrequently seen in medical practice. Infective endocarditis (IE) can occur as rare complications of VA shunts, through the introduction of a foreign body close to the tricuspid valve. We report a case of infective endocarditis, that is, in a patient with VA shunt for congenital hydrocephalus. We present the case to highlight the importance of early investigation for IE in patients with fever of unknown origin and shunt in situ, as rapid deterioration can occur and be fatal. We also discuss past experience reported in the literature on the role of cardiothoracic intervention. Prompt diagnosis and early cardiothoracic referral for surgery are crucial, there may only be a narrow window of opportunity for intervention before patients develop fulminant sepsis.

  • cardiothoracic surgery
  • neurosurgery
  • infectious diseases

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Footnotes

  • Contributors RS—consent, writing case report. RW—editing of case report. SH—idea for manuscript, editing of case report. NB—idea for manuscript, editing of case report. Both authors contributed equally as senior overview of the manuscript.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Next of kin consent obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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