Introduction: Malfunction of cerebrospinal shunts is common and is due to multiple etiologies ranging from obstruction due to infiltrated brain tissue to mechanical disconnection.
Discussion: We review the differential diagnosis and recommended evaluation and treatment for cerebrospinal fluid (CSF) eosinophilia.
Illustrative case: We report a child who, following the use of an antibiotics-impregnated ventricular catheter, developed sterile ventriculoperitoneal shunt malfunction thought to be due to profound CSF eosinophilia. Following removal of the catheter, the eosinophilia spontaneously resolved, and at long-term follow up, the patient has a functioning non-antibiotic impregnated shunt catheter.
Conclusions: Patients presenting with signs of shunt malfunction but without signs of CSF infection and with a raised CSF eosinophilia should be suspicious for cellular obstruction of their shunt system, i.e., sterile shunt malfunction.