Rare Postoperative Pelvic Lymphocyst Infection by Streptococcus mitis/oralis: A Case Study

Xiaoyu Cheng,1– 3 Anping Guo,1,2 Fengmei Wang3 1Department of Pharmacy, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, Anhui, People’s Republic of China; 2Anhui Provincial Key Laboratory of Precision Pharmaceutical Preparations and Clinical Pharmacy, Hefei, Anhui, People’s Republic of China; 3Women’s Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang, People’s Republic of ChinaCorrespondence: Fengmei Wang, Email fmwang@zju.edu.cn Anping Guo, Email ganpingah@163.comAbstract: Lymphatic cyst with infection is caused by interruption of lymphatic vessels during para-aortic lymphnode dissection in patients with gynecological malignancies. It is generally considered that the infection is caused by bacteria invading through the lower limb and perineal wound, but the pathogenic factors of most lymphatic cysts are not clear. Our literature search revealed no previously reported cases similar to ours, in which a lymphatic cyst infection resulted from a co-infection with Streptococcus mitis/oralis (S. mitis/oralis) and Klebsiella pneumoniae (K. pneumoniae). A woman of 61 years of age, was diagnosed in endometrial cancer, carcinosarcoma FIGO grade 3, stage IIIC of the FIGO system. During the third postoperative pelvic replacement and drainage procedure, the patient developed a fever with a peak temperature of 39.2°C on the second day after the removal of the drainage tube. Empiric broad-spectrum antibiotics were started upon hospital readmission, but the patient showed poor response to therapy, with persistent and recurrent lower abdominal tenderness, raising concern for ongoing intra-abdominal or pelvic infection. As a result, it is important to identify pathogenic bacteria associated with lymphatic cyst infections and determine antimicrobial regimens. We further investigated the pathogenicity and antibiotic resistance of S. mitis/oralis, formulated an appropriate anti-infective treatment strategies. Consequently, the patient recovered and was discharged.Keywords: gynecological malignancies, lymphatic cyst, infection, Streptococcus mitis/oralis