Locally advanced
cervical cancer occasionally induces
pyometra, but there have been no reports of
meningitis where
pyometra is the cause of
infection. Here, we report a case of
Listeria monocytogenes meningitis related to
pyometra during
concurrent chemoradiotherapy (CCRT) in a
cervical cancer patient. The patient, a 77-year-old woman, was diagnosed with Stage IIB (FIGO 2018) cervical
adenocarcinoma, and CCRT was initiated.
Pyometra was exacerbated during CCRT, and after her first
brachytherapy, she presented at our hospital with
fever and decreased consciousness level. After admission to the Intensive Care Unit, the patient lost consciousness and experienced frequent
seizures; tracheal intubation was required. Whole-body computed tomography revealed
pyometra; therefore, transvaginal removal of the
abscess was performed. Laboratory tests and vital signs indicated
septic shock, and
meropenem was administered. L. monocytogenes was detected in the
abscess from the uterine cavity and the blood cultures on the third day of hospitalization. A lumbar puncture was performed on the same day to investigate whether the patient had
meningitis. A FilmArray
meningitis/
encephalitis panel test of the spinal fluid revealed L. monocytogenes. After the diagnosis of
meningitis with L. monocytogenes,
ampicillin and
gentamicin were started, and the blood test results gradually improved. Five months after the initial episode, her consciousness recovered, however she still received mechanical ventilatory support. L. monocytogenes
infections can occur in patients undergoing
chemotherapy, even without the use of
steroids or
immunosuppressive agents. In cases with
pyometra, intrauterine manipulation can increase the risk of severe
infection.