• Marc Zanello, Eric Bozier, and Johan Pallud.
• Department of Neurosurgery, GHU site Sainte-Anne, Paris, France; Institute of Psychiatry and Neurosciences of Paris, INSERM, University of Paris, Paris, France. Electronic address: zanello.marc@gmail.com.
• World Neurosurg. 2022 Mar 1; 159: 144-145.

AbstractDelayed infection from an implanted device can be challenging to diagnose. Here, we report a case of a 56-year-old male patient with history of congenital hydrocephalus and previous placement of a ventriculoperitoneal (VP) shunt who presented with sepsis without any evidence of shunt infection at follow-up 3 years after his most recent shunt implantation. The VP shunt contained 2 residual ventricular catheters and 2 residual peritoneal catheters, as the patient has had multiple VP shunt revisions since childhood. The patient was unresponsive to multiple antibiotic regimens. Of note, 2-[18]-fluoro-2-deoxy-D-glucose-positron emission tomography scan revealed hypermetabolism at the distal end of the latest implanted abdominal catheter without any abnormality of migrated cerebral catheters, highlighting the advantageous use of 2-[18]-fluoro-2-deoxy-D-glucose-positron emission tomography to identify the infected catheter when multiple devices are involved. Removal of abdominal catheters confirmed the localized infection, and follow-up was uneventful after shunt replacement.Copyright © 2022 Elsevier Inc. All rights reserved.

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