Shunt nephritis with right-sided infective endocarditis caused by <i>Staphylococcus epidermidis</i> in a patient with prolonged pyrexia and renal dysfunction

Shunt nephritis is a rare immune-complex mediated glomerulonephritis associated with infected ventriculo-atrial (VA) shunts and is increasingly uncommon in contemporary practice. We report a diagnostically challenging case of shunt nephritis with concomitant right-sided infective endocarditis caused by Staphylococcus epidermidis, presenting with prolonged pyrexia and renal dysfunction. A 62-year-old woman presented with an 18-month history of fever, weight loss, and malaise, initially treated as recurrent urinary tract infection and later as histoplasmosis without improvement. She had a prior history of subarachnoid haemorrhage requiring shunt placement, later revised to a VA shunt. Evaluation revealed anaemia, proteinuria, elevated creatinine, and sterile pyuria. Repeated blood cultures and cerebrospinal fluid obtained via shunt tap grew methicillin-resistant coagulase-negative Staphylococcus epidermidis, confirming device-associated infection. Renal biopsy demonstrated crescentic glomerulonephritis consistent with immune-complex nephritis. Trans-oesophageal echocardiography identified large vegetations involving the right atrium and tricuspid valve, establishing right-sided infective endocarditis. The patient was treated with renal-adjusted intravenous antibiotics, resulting in clinical and biochemical improvement. Definitive management with shunt removal and conversion to a ventriculoperitoneal shunt led to complete recovery with sterile follow-up cultures. This case highlights the diagnostic complexity of shunt nephritis, particularly in the context of prolonged fever and nonspecific findings. Persistent coagulase-negative staphylococcal bacteraemia should not be dismissed as contamination in patients with indwelling devices. Early recognition, combined with targeted antimicrobial therapy and timely shunt removal, is essential to prevent irreversible renal damage and associated complications.