Sivasubramanian Geetha
Division of Infectious Diseases, University of California, San Francisco, Fresno, California, USA.
Open Forum Infect Dis. 2025 Aug 12;12(8):ofaf486. doi: 10.1093/ofid/ofaf486. eCollection 2025 Aug.
Ventriculoperitoneal (VP) shunts are the mainstay for cerebrospinal fluid diversion in patients with refractory coccidioidal meningitis (CM)-associated hydrocephalus. Abdominal pseudocysts (APCs), an uncommon but known complication of distal shunt catheters, have not been well described in CM. We conducted a retrospective study of 124 patients with CM who underwent VP shunt placement between 2010 and 2024. APCs occurred in 21 patients (17%), with most presenting with symptoms of shunt malfunction rather than abdominal complaints. This incidence is notably higher than previously reported in patients with hydrocephalus due to other etiologies. Evidence of active infection was present in 71% of patients. Imaging typically revealed fluid collections at the distal catheter tip, and most patients underwent surgical intervention targeting the distal shunt. Despite intervention, recurrent shunt failures occurred in a substantial proportion. These findings add to the limited literature on APCs in CM and may inform future research into their presentation, contributing factors, and management.
脑室腹腔（VP）分流术是难治性球孢子菌性脑膜炎（CM）相关脑积水患者脑脊液引流的主要手段。腹部假性囊肿（APC）是远端分流导管一种不常见但已知的并发症，在CM中尚未得到充分描述。我们对2010年至2024年间接受VP分流术的124例CM患者进行了一项回顾性研究。21例患者（17%）发生了APC，大多数患者表现为分流功能障碍症状而非腹部不适。这一发生率明显高于先前报道的其他病因导致脑积水患者的发生率。71%的患者存在活动性感染证据。影像学检查通常显示远端导管尖端有积液，大多数患者接受了针对远端分流的手术干预。尽管进行了干预，但仍有相当比例的患者出现分流反复失败。这些发现增加了关于CM中APC的有限文献，并可能为未来对其表现、促成因素和管理的研究提供参考。
