Ventriculoperitoneal Shunt-Associated Vancomycin-Resistant Meningitis Complicating a Patient Undergoing Plasmapheresis for Presumed Systemic Lupus Erythematosus-Associated Transverse Myelitis

Abstract

Objectives We report a patient who had a working diagnosis of transverse myelitis secondary to a lupus exacerbation. As his clinical course evolved, continued vigilance clarified that he was in fact suffering from a nosocomial infection caused by vancomycin-resistant Enterococcus (VRE).

Methods We performed a retrospective review of the patient's medical record.

Results Despite radiographic improvement, he did not improve clinically following immunosuppressive therapy including plasma exchange. Once meningitis was diagnosed and treated, he improved rapidly.

Conclusion The prospect of transverse myelitis may confound the diagnosis of VRE meningitis, a uniquely treated and potentially deadly infection.

Keywords

vancomycin-resistant meningitis - ventriculoperitoneal shunt - nosocomial infection - transverse myelitis - systemic lupus erythematosus - plasmapheresis

• References

• 1 Krishnan C, Greenberg B, Kerr D. Transverse Myelitis. In: UpToDate, Gonzalez-Scarano F. , ed. UpToDate, Waltham, MA. https://www.uptodate.com/contents/transverse-myelitis . Accessed on March 11, 2014
• 2 Schwartz J, Winters JL, Padmanabhan A. , et al. Guidelines on the use of therapeutic apheresis in clinical practice-evidence-based approach from the Writing Committee of the American Society for Apheresis: the sixth special issue. J Clin Apher 2013; 28 (03) 145-284
• 3 Le J, Bookstaver PB, Rudisill CN. , et al. Treatment of meningitis caused by vancomycin-resistant Enterococcus faecium: high-dose and combination daptomycin therapy. Ann Pharmacother 2010; 44 (12) 2001-2006