Ventriculoperitoneal Shunt-Associated Vancomycin-Resistant Meningitis Complicating a Patient Undergoing Plasmapheresis for Presumed Systemic Lupus Erythematosus-Associated Transverse Myelitis.

Objectives  We report a patient who had a working diagnosis of transverse myelitis secondary to a lupus exacerbation. As his clinical course evolved, continued vigilance clarified that he was in fact suffering from a nosocomial infection caused by vancomycin-resistant Enterococcus (VRE). Methods  We performed a retrospective review of the patient's medical record. Results  Despite radiographic improvement, he did not improve clinically following immunosuppressive therapy including plasma exchange. Once meningitis was diagnosed and treated, he improved rapidly. Conclusion  The prospect of transverse myelitis may confound the diagnosis of VRE meningitis, a uniquely treated and potentially deadly infection.