Ventriculitis, Secondary to Septicaemia - Erler Zimmer

Ventriculitis, Secondary to Septicaemia - Erler Zimmer

Clinical History

A 50-year-old alcoholic was admitted with a 2-week history of weakness and shortness of breath. At the onset of the illness, he reported a productive cough, chest pain, and blood-stained sputum. Examination revealed a febrile, cyanosed, drowsy man with grunting respiration. A friction rub was present over the right lower lobe. The remainder of the examination was unremarkable. The patient steadily deteriorated, and on the morning of his death, a lumbar puncture was performed, yielding green opalescent fluid. A blood culture grew Streptococcus pneumoniae.

Pathology

This specimen illustrates ventriculitis, accompanied by pneumococcal meningitis and right basal pneumonia identified during autopsy. The horizontal slice through both cerebral hemispheres reveals both lateral ventricles, showcasing a thickened, rough ependymal lining with the accumulation of cellular debris around the choroid plexus and in the anterior horn. The lower surface exhibits similar changes and displays the normal arrangement of the caudate nucleus, lentiform nucleus, and internal capsule. Histology reveals extensive neutrophil infiltration in the subarachnoid space, as well as multifocal severe (sub)endothelial infiltration obstructing vascular lumens and affecting blood vessel walls. The inflammation extends into the cerebral parenchyma, causing hemorrhage and necrosis.

Further Information

Ventriculitis is an uncommon complication of intracranial infection. In adults, it more commonly occurs as a secondary complication of surgical intervention or trauma than from primary community-acquired meningitis. In these cases, the causative organisms are similar to other nosocomial (hospital-acquired) infections, particularly staphylococci or resistant Gram-negative bacilli. Neonates aged less than 6 months have a higher incidence of ventricular infection. Presentation may be more subtle than in bacterial meningitis or may manifest as obstructive hydrocephalus, secondary to resulting aqueductal obstruction. Diagnosis relies on laboratory CSF testing and imaging, especially using CT scans and MRI. Prolonged intravenous antibiotic therapy is a mainstay of treatment with consideration given to achieving effective concentrations in CSF and brain tissue.