Successful Treatment of Refractory Ventriculitis With Intraventricular Liposomal Amphotericin B.

We report on a case of a patient in their early 60's with a history of traumatic brain injury, decompressive cranioplasty, and chronic ventriculoperitoneal (VP) shunt who presented from a nursing home with altered mental status and status epilepticus. He was found to have growing from his cerebrospinal fluid (CSF) cultures. Initial management included removal of the VP shunt, placement and two exchanges of external ventricular drains (EVD), and treatment with various antifungal regimens, including intraventricular liposomal amphotericin B. Despite these measures, the patient had a persistent ventriculitis that lasted over 4 weeks. Due to the refractory infection, we also performed therapeutic drug monitoring to determine the degree of antifungal penetration into the CSF. In this report, we aim to describe our approach in treating a challenging case of ventriculitis.