E. coli Pyogenic Ventriculitis: A Comprehensive Case Report

Area of Science:

• Neurology
• Infectious Diseases
• Critical Care Medicine

Background:

• Pyogenic ventriculitis is a rare complication of bacterial meningitis, often linked to compromised immunity or ventricular catheters.
• Gram-negative organism involvement in ventriculitis is uncommon and typically associated with catheterization.

Observation:

• A 48-year-old female with a history of cervical cancer and pelvic radiation presented with symptoms of meningitis and ventriculitis.
• The patient had a sigmoid colon fistula leading to vertebral osteomyelitis and subsequent cerebrospinal fluid inoculation.
• Escherichia coli (E. coli) was identified as the causative agent, leading to bacteremia.

Findings:

• The case presents an unusual etiology of ventriculitis, not related to ventricular catheters.
• Diagnostic findings and potential treatment strategies for this atypical presentation are discussed.
• The patient's extensive comorbidities influenced the treatment decision towards supportive care despite E. coli bacteremia.

Implications:

• This case underscores the importance of considering non-catheter-related causes of ventriculitis, especially in patients with specific risk factors.
• It emphasizes the need for thorough investigation into potential sources of infection, such as gastrointestinal fistulas.
• The report highlights challenges in managing rare infections in patients with significant comorbidities and discusses alternative therapeutic considerations.