Choroid Plexus Hyperplasia with Intractable Ascites and a Resulting Communicating Hydrocele following Shunt Operation for Hydrocephalus

De novo mutation of CYBB gene in a boy presenting as intra-abdominal infection of Burkholderia contaminans: a case report

Background

Chronic granulomatous disease (CGD) is an inborn error of immunity. It is characterized by recurrent bacterial or fungal infections, including infections by Burkholderia species. This is due to respiratory burst dysfunction of phagocytes. Currently, there is no report on Burkholderia contaminans (B. Contaminans) infection in children with CGD.

Case presentation

We present a previously healthy, 17-month-old Chinese boy infected with B. Contaminans in the intra-abdominal regions. Immunological screening, including assessment of cellular immunity and humoral immunity did not yield conclusive results. The level of nicotinamide adenine dinucleotide phosphatase (NADPH) activity was decreased and whole-exome sequencing identified a de novo mutation in the CYBB gene.

Conclusions

For specific pathogens such as B. Contaminans, immune assessment should be carried out even if there is no positive medical history or specificity in basic immunity screening.

Ventriculoperitoneal Shunt-Associated Ascites: A Case Report

A ventriculoperitoneal shunt is a commonly performed procedure that is used to relieve the increased intracranial pressure in patients with hydrocephalus. VP shunt placement is an invasive procedure and carries many complications. Besides common complications like infections or mechanical obstruction, VP shunt has been found to be associated with the development of ascites in some patients. VP shunt-associated ascites is a very rare complication and only a few cases have been reported in the literature, most of which were in the pediatric population, while adult VP shunt-associated ascites was even rarer.

The patient in this case is a 32-year-old female who presented with ascites of unclear etiology. She had a history of VP shunt placement shortly after birth due to central nervous system (CNS) malformation (agenesis of the corpus callosum). Liver pathology, infection, and malignancy were ruled out as potential causes, and ascites was determined to be due to VP shunt drainage.

The exact mechanism of development of ascites in these patients is not fully understood and needs to be investigated further to optimize preventative and therapeutic options.

Benign Postnatal Outcome after Prenatal Diagnosis of Fetal Ventriculomegaly with Choroid Plexus Hyperplasia: A Case Report

Prenatal counselling following the diagnosis of fetal ventriculomegaly is challenging. Fetal MRI (magnetic resonance imaging) can be helpful in characterizing ventriculomegaly severity and associated anomalies, hence contributing to prognosis establishment. Choroid plexus hyperplasia (CPH) is a rare entity characterized by enlargement of the choroid plexuses, usually progressing to severe hydrocephalus with an associated poor outcome. We present a case of CPH diagnosed by fetal MRI at 23 weeks of gestation following referral for ventriculomegaly. The pregnancy was carried to term and the child was monitored clinically and radiologically. Despite the persistence of enlarged choroid plexuses, the ventricular size has progressively decreased, and at the 4-year follow-up the child presented normal psychomotor development. This case highlights the added value of MRI in prenatal diagnosis of fetal ventriculomegaly and its management. The unusual benign outcome in this case can be considered for parental counselling when faced with a fetus with similar findings.