Letter to the Editor
Uterine pyometra by Eggertella lenta
Piometra uterino por Eggertella lenta
Herminia Lozano Gómez
, Sandra Herrero García, Blanca Obón Azuara
Corresponding author
Servicio de Medicina Intensiva, Hospital Clínico Universitario Lozano Blesa, Zargoza, Spain
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Previously called <span class="elsevierStyleItalic">Eubacterium</span>, it has been reclassified under the bacterial genus Actinobacteria.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,2</span></a> It has generally been associated with infections of the gastrointestinal and genitourinary tract and has been linked to polymicrobial infections (50%). Compared to other gram-positive bacteria, <span class="elsevierStyleItalic">E. lenta</span> is an important cause of bacteraemia, secondary to intestinal bacterial translocation, although it is rarely isolated from intra-abdominal fluid samples.</p><p id="par0010" class="elsevierStylePara elsevierViewall">Risk factors include alterations in immunocompetence, diabetes mellitus, final stages of chronic kidney failure, ulcerative colitis or Crohn's disease, and neoplasms.<a class="elsevierStyleCrossRef" href="#bib0015"><span class="elsevierStyleSup">3</span></a> The mean age of presentation is 55 and it is more common in women.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a> Its mortality exceeds 35%.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a></p><p id="par0015" class="elsevierStylePara elsevierViewall">It is a slow-growing microorganism, hence the difficulty in its laboratory isolation. In recent years, the development of new techniques and the use of MALDI-TOF MS have allowed a fast and reliable diagnosis.</p><p id="par0020" class="elsevierStylePara elsevierViewall">We report the case of a 70-year-old woman with a history of obesity surgery, difficult-to-control asthma, atrial fibrillation anticoagulated with apixaban, moderate degenerative aortic regurgitation, and acute urine retention, for which she was a permanent urinary catheterization patient.</p><p id="par0025" class="elsevierStylePara elsevierViewall">She went to the emergency department due to sudden pain in the hypogastrium and in the left iliac fossa. In the previous days, she had reported dysuria, so her primary care doctor prescribed fosfomycin treatment.</p><p id="par0030" class="elsevierStylePara elsevierViewall">During the first clinical assessment, she had developed a condition of shock with hypotension (BP 90/60), tachycardia and oliguria. Evidence of severe metabolic acidosis, exacerbated chronic renal failure and hyperlactacidemia, as well as significant elevation of inflammatory parameters in blood tests were observed. An abdominal computed tomography showed free perihepatic and perisplenic fluid between the loops and in the lesser pelvis, without other relevant findings.</p><p id="par0035" class="elsevierStylePara elsevierViewall">She was admitted to the intensive care unit for stabilization, initiation of intense fluid therapy and vasoactive drug treatment. Once blood and urine cultures were taken, broad-spectrum antibiotic treatment with carbapenem and linezolid was started.</p><p id="par0040" class="elsevierStylePara elsevierViewall">After evaluation by general surgery, an exploratory laparotomy was performed with the finding of uterine vault perforation and purulent peritonitis of the 4 quadrants, requiring hysterectomy and double adnexectomy. She experienced a had a good recovery during the following hours, with discontinuation of vasoactive drugs and improvement of renal function. <span class="elsevierStyleItalic">Enterococcus avium</span> susceptible to linezolid was isolated in the peritoneal fluid, while <span class="elsevierStyleItalic">E. lenta</span> sensitive to piperacillin/tazobactam isolates were found in blood cultures, with subsequent antibiotic treatment adjustment. Anatomical pathology revealed uterine perforation as a result of pyometra, with involvement of all muscle layers.</p><p id="par0045" class="elsevierStylePara elsevierViewall">The postoperative period was torpid in terms of breathing, with several episodes of complete unilateral pulmonary atelectasis, for which 2 fibreoptic bronchoscopies were performed, as well as orotracheal reintubation due to respiratory failure.</p><p id="par0050" class="elsevierStylePara elsevierViewall">The patient was discharged to the hospital ward after 20 days in the ICU, where she died of respiratory failure.</p><p id="par0055" class="elsevierStylePara elsevierViewall">In recent years <span class="elsevierStyleItalic">E. lenta</span> has been reclassified into an independent genus, acquiring this new name in 1999.</p><p id="par0060" class="elsevierStylePara elsevierViewall">Its diagnosis has been made easier in recent years thanks to the sequencing of ribosomal RNA and the incorporation of techniques such as MALDI-TOF MS. However, it is a rare microorganism whose pathophysiology is not known with certainty.<a class="elsevierStyleCrossRefs" href="#bib0005"><span class="elsevierStyleSup">1,3</span></a></p><p id="par0065" class="elsevierStylePara elsevierViewall">In our case, it is a pathogen associated with a severe intra-abdominal infection, generally due to hollow viscus perforation. The association with skin and soft tissue infections, such as polyserositis, and patients with pressure ulcers is not uncommon. The typical clinical course is the development of bacteraemia as a consequence of an intestinal bacterial translocation.<a class="elsevierStyleCrossRef" href="#bib0020"><span class="elsevierStyleSup">4</span></a></p><p id="par0070" class="elsevierStylePara elsevierViewall">There are many cases where this pathogen is isolated in association with polymicrobial infections, which often leads to it being considered a contaminating agent, resulting in increased mortality, as it is not considered to be responsible for the disease.<a class="elsevierStyleCrossRef" href="#bib0010"><span class="elsevierStyleSup">2</span></a></p><p id="par0075" class="elsevierStylePara elsevierViewall">In terms of antimicrobial treatment, high minimum inhibitory concentrations have been described for penicillins and piperacillin-tazobactam, one of the most commonly used empirical treatments, which could explain the high mortality of these infections.<a class="elsevierStyleCrossRefs" href="#bib0020"><span class="elsevierStyleSup">4,5</span></a></p></span>" "pdfFichero" => "main.pdf" "tienePdf" => true "NotaPie" => array:1 [ 0 => array:2 [ "etiqueta" => "☆" "nota" => "<p class="elsevierStyleNotepara" id="npar0005">Please cite this article as: Lozano Gómez H, Herrero García S, Obón Azuara B. Piometra uterino por <span class="elsevierStyleItalic">Eggertella lenta</span>. Med Clin (Barc). 2021;157:400–401.</p>" ] ] "bibliografia" => array:2 [ "titulo" => "References" "seccion" => array:1 [ 0 => array:2 [ "identificador" => "bibs0005" "bibliografiaReferencia" => array:5 [ 0 => array:3 [ "identificador" => "bib0005" "etiqueta" => "1" "referencia" => array:1 [ 0 => array:2 [ "contribucion" => array:1 [ 0 => array:2 [ "titulo" => "Clinical and microbiological characteristics of <span class="elsevierStyleItalic">Eggerthella lenta</span> bacteremia" "autores" => array:1 [ 0 => array:2 [ "etal" => true "autores" => array:6 [ 0 => "B.J. Gardiner" 1 => "A.Y. Tai" 2 => "D. Kotsanas" 3 => "M.J. Francis" 4 => "S.A. Roberts" 5 => "S.A. Ballard" ] ] ] ] ] "host" => array:1 [ 0 => array:2 [ "doi" => "10.1128/JCM.02926-14" "Revista" => array:6 [ "tituloSerie" => "J Clin Microbiol." 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