Aseptic meningitis after intraventricular administration of gentamicin

Infection of the central nervous system (CNS) is a major cause of morbidity in patients with cerebrospinal fluid (CSF) shunts. Intraventricular admini stration of gentamicin, in combination with systemic antibiotics and shunt removal, may be beneficial in treating these infections. A young child was treated successfully for a ventriculoperitoneal shunt infection while recei ving systemic nafcillin and intraventricular gentamicin. During treatment s he developed CNS toxicity resembling aseptic meningitis. Based on CSF genta micin levels and differential white blood cell counts, it was suspected tha t gentamicin was causing meningeal inflammation. Discontinuation of the dru g relieved her symptoms. Rebound CSF leukocytosis associated with lymphocyt e increase, despite a negative CSF culture, can indicate aseptic meningitis when drugs are administered intraventricularly. Clinicians should evaluate CSF cell count differentials before concluding treatment failure when admi nistering antibiotics intraventricularly for meningitis.