J Neurocrit Care.  2017 Dec;10(2):112-115. 10.18700/jnc.170011.

Ventriculitis Associated with Extended Spectrum Beta-Lactamase Producing Klebsiella pneumoniae after Acupuncture

• Park SH
• Ryu WS

• KMID: 2405766
• DOI: http://doi.org/10.18700/jnc.170011

Abstract

BACKGROUND
Ventriculitis is a rare and critical infection of the central nervous system. Here, we report a case of ventriculitis by extended spectrum beta-lactamase (ESBL) producing Klebsiella pneumoniae , after acupuncture at the low back.
CASE REPORT
A 72-year-old woman visited our center with fever, headache, and decreased mental status, after undergoing low back acupuncture. Brain imaging showed the fluid-debris level in the lateral ventricle, suggesting ventriculitis. ESBL producing Klebsiella pneumoniae were cultured from the cerebrospinal fluid. After the administration of antibiotics, although the ventriculitis was treated, the quadriplegia remained.
CONCLUSIONS
This case stresses the importance of aseptic techniques during acupuncture.

Keyword

Cerebral ventriculitis; Klebsiella pneumoniae; beta-Lactamases; Acupuncture

MeSH Terms

Acupuncture*
Aged
Anti-Bacterial Agents
beta-Lactamases*
Central Nervous System
Cerebral Ventriculitis
Cerebrospinal Fluid
Female
Fever
Headache
Humans
Klebsiella pneumoniae*
Klebsiella*
Lateral Ventricles
Neuroimaging
Quadriplegia
Anti-Bacterial Agents
beta-Lactamases

Figure

• 

  Figure 1. Brain CT showed diffuse ventriculomegaly with fluid level (white arrows), suggesting hydrocephalus and ventriculitis. Brain CT showed multifocal low attenuation in periventricular white matter, suggesting chronic ischemic lesion or interstitial edema. CT, computed tomography.

• 

  Figure 2. Diffusion-weighted brain magnetic resonance imaging (A) showed diffuse subtle high signal intensity along the sulci, and ventricular enlargement. Fluid-attenuated inversion recovery image (B) showed fluid-debris levels (white arrows) in both occipital horns.

• 

  Figure 3. Follow-up brain computed tomography showed remarkable improvement with hydrocephalus and ventriculitis.

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