2020 Volume 53 Issue 9 Pages 725-731
Herein, we report a case of bacterial meningitis caused by Enterococcus faecium that was diagnosed following laparoscopic total proctocolectomy to treat ulcerative colitis. A 60-year-old man with refractory, active-phase ulcerative colitis was admitted and treated with laparoscopic total colectomy, ileal pouch-anal anastomosis, and ileostomy. The patient suffered from sepsis-associated disseminated intravascular coagulation during the perioperative period, and despite antibiotic treatment for differential diagnoses, including pneumonia and intra-abdominal infection, his remittent fever and disturbance of consciousness persisted. Sixty-three days after surgery, we performed head MRI and cerebrospinal fluid analysis, both of which indicated bacterial meningitis. Accordingly, after we treated the patient with targeted antibiotics for six weeks, his remittent fever and disturbance of consciousness dissipated. No evidence of bacterial meningitis was found in a subsequent head MRI or cerebrospinal fluid analysis. Perioperative bacterial meningitis following surgery for ulcerative colitis is, as in this case, extremely rare and difficult to diagnose.
