Intra-Abdominal Ventriculoperitoneal Shunt Abscess from Streptococcus Pyogenes after Pharyngitis with Scarlet Fever: Case Report and Review of the Literature

Abstract

Objective: Infection is one of the most frequent complications of ventriculoperitoneal shunts.
However, Streptococcus pyogenes (Group A Streptococcus, GAS) as a causative agent appears
to be extremely rare. We present an unusual case of a peritoneal shunt infection due to GAS that
occurred after pharyngitis with scarlet fever.
Case Description: A 31 year-old woman with congenital shunt-dependent hydrocephalus presented with fever, vomiting, and acute abdominal symptoms several weeks after being treated
for pharyngitis and scarlet fever. She was found to have a large intra-abdominal peritoneal
catheter-associated abscess that grew out GAS.
Results: The patient’s shunt was externalized at the clavicle and the cerebrospinal fluid (CSF)
was sterile. Her peritoneal abscess was treated by percutaneous drainage, laparotomy, and intravenous antibiotics. More permanent CSF diversion was accomplished via ventriculoatrial
shunt creation after treatment. She made a full recovery.
Conclusion: While shunt infection is an all too common clinical problem, this is the first report
of a peritoneal shunt infection caused by GAS after pharyngitis and scarlet fever. Presumably,
this infection occurred as a result of haematogenous spread to the shunt site in the abdomen.