Atypical delayed ventriculoperitoneal shunt infection following hysteroscopic polypectomy: illustrative case.

backgroundA 36-year-old female with a history of congenital hydrocephalus, treated with ventriculoperitoneal (VP) shunt placement at 3 months of age and a shunt revision at 9 years of age, presented with erythema, induration, and drainage of an abdominal incision through which the distal catheter of her VP shunt had been implanted many years prior. She had no recent risk factors for infection apart from a minor transvaginal gynecological procedure that involved hysteroscopy with dilation and curettage for uterine polyps. OBSERVATIONS: Abdominal wound cultures grew Cutibacterium acnes, Corynebacterium species, and Mycobacterium chelonae. She was managed with initial externalization, followed by complete explantation of her shunt system following a successful clamp trial; in tandem, the atypical polymicrobial infection was treated with a prolonged regimen of intravenous antibiotics followed by oral antibiotics and close monitoring of the wound, which healed appropriately. LESSONS: Although the majority of shunt infections occur due to a characteristic set of organisms within an expected time frame, this case emphasizes the importance of a thorough workup and follow-up for shunt-treated patients with potential infections-even when they fall outside the usual window or have an atypical presentation-for the possibility of uncommon infecting organisms. https://thejns.org/doi/10.3171/CASE24472.