# E. coli Pyogenic Ventriculitis: A Comprehensive Case Report

## TL;DR

This case report describes a rare instance of E. coli pyogenic ventriculitis in a 48-year-old woman with a complex medical history.

## Contribution

The novelty lies in the unique presentation of E. coli ventriculitis linked to a sigmoid colon fistula and vertebral osteomyelitis in a non-immunocompromised adult.

## Key findings

- E. coli pyogenic ventriculitis occurred in a patient with a sigmoid colon fistula and vertebral osteomyelitis.
- The case highlights the importance of considering unusual sources of infection in ventriculitis diagnosis.
- The patient's extensive comorbidities influenced the decision to pursue supportive care over aggressive treatment.

## Abstract

Pyogenic ventriculitis is a rare complication of bacterial meningitis, more commonly observed in individuals with compromised immune systems. Furthermore, when caused by a gram-negative organism, these cases have largely been reported as ventricular catheter-related. This case report presents a unique instance of pyogenic ventriculitis caused by Escherichia coli (E. coli) in a 48-year-old female, wherein a sigmoid colon fistula led to vertebral osteomyelitis and subsequent inoculation of the cerebrospinal fluid. The patient presented with chronic back pain and a one-week history of fever, nausea, vomiting, and generalized weakness. In addition to these symptoms, the patient also had a significant medical and surgical history, with cervical cancer and pelvic radiation exposure being two notable features. Although antibiotic therapy was provided due to E. coli bacteremia, a decision to pursue supportive care was made given the presence of extensive comorbidities. Therefore, the purpose of this case report is not only to discuss an atypical case of meningitis/ventriculitis, but also to emphasize diagnostic findings and treatment options that could have been used for our patient if circumstances permitted.