First case of Cutibacterium avidum-infected pelvic lymphocele post-lymphadenectomy for endometrial cancer: A case report

Hirokazu Toyoshima; Motoaki Tanigawa; Kanako Nakamura; Chiaki Ishiguro; Hiroyuki Tanaka; Yuki Nakanishi; Shigetoshi Sakabe

doi:10.1016/j.heliyon.2023.e21396

First case of Cutibacterium avidum-infected pelvic lymphocele post-lymphadenectomy for endometrial cancer: A case report

Heliyon. 2023 Oct 21;9(11):e21396. doi: 10.1016/j.heliyon.2023.e21396. eCollection 2023 Nov.

Authors

Hirokazu Toyoshima^{1

2}, Motoaki Tanigawa³, Kanako Nakamura⁴, Chiaki Ishiguro^{2

4}, Hiroyuki Tanaka¹, Yuki Nakanishi¹, Shigetoshi Sakabe¹

Affiliations

¹ Department of Infectious Diseases, Japanese Red Cross Ise Hospital, 1-471-2, Funae, Ise, Mie, 516-8512, Japan.
² Infection Prevention and Control Office, Japanese Red Cross Ise Hospital, Ise, 516-8512, Japan.
³ Department of Respiratory Medicine, Japanese Red Cross Ise Hospital, 1-471-2, Funae, Ise, Mie, 516-8512, Japan.
⁴ Department of Medical Technology, Japanese Red Cross Ise Hospital, 1-471-2, Funae, Ise, Mie, 516-8512, Japan.

Abstract

Background: Pelvic lymphocele (lymphocyst) infection after lymphadenectomy is a rare complication that can cause the spread of inflammation to neighboring organs whose microbiology is not well known. Cutibacterium avidum causes various infections. However, no case reports of C. avidum pelvic lymphocele infection are available; therefore, its clinical characteristics in pelvic lymphocele infections remain unknown.

Case presentation: A 38-year-old woman with obesity (body mass index: 38.1 kg/m²) and a history of pelvic lymphadenectomy and chemotherapy for endometrial cancer presented with worsening left lower quadrant (LLQ) pain with fever. Physical examination revealed decreased abdominal bowel sounds and tenderness on LLQ palpation with no signs of peritonitis. Computed tomography (CT) revealed an infected left pelvic lymphocele with inflammation spreading to the adjacent sigmoid colon. Following blood culture, ampicillin/sulbactam (2 g/1 g every 6 h) was administered intravenously. Anaerobic culture bottles revealed gram-positive rods on day 4 of incubation at 37 °C. No other disseminated foci were observed in enhanced whole-body CT and upon transthoracic echocardiography. The isolates grew aerobically and anaerobically on blood agar plates with strong hemolysis. The bacterium was identified as C. avidum using a combination of characteristic peak analysis with matrix-assisted laser desorption ionization (MALDI) and 16S rRNA gene sequencing. The patient was diagnosed with C. avidum pelvic lymphocele infection. Based on penicillin susceptibility, the patient was successfully treated with intravenous ampicillin/sulbactam and de-escalated with intravenous ampicillin (2 g every 6 h) for 10 days, followed by oral amoxicillin (2000 mg/day) for an additional 11 days without drainage.

Conclusions: C. avidum should be considered a causative microorganism of pelvic lymphocele infection. Peak analysis using MALDI and distinctive growth on blood agar plates are suitable for identifying C. avidum. Mild pelvic lymphocele caused by C. avidum can be treated with a short course of appropriate antimicrobial treatment without surgical intervention.

Keywords: 16S rRNA gene sequencing; Case report; Cutibacterium avidum; Infection; Lymphocele; Lymphocyst; Matrix-assisted laser desorption ionization; Peak analysis.

Publication types

Case Reports