Listeria monocytogenes rhombencephalitis: a case report and review of current literature.

BACKGROUND

Listeria monocytogenes Meningoencephalitis is a rare but potentially severe and lethal infectious disease caused by Listeria monocytogenes invading the central nervous system. The infection mainly affects the immunocompromised, neonates and older adults.

CASE REPORT: A 71-year-old woman without relevant medical history was referred to the emergency department with febrile gastroenteritis. Upon admission, neurological examination was normal. Ten hours after admission, an acute neurological deterioration was observed, with the patient exhibiting incoherent speech and ocular motility abnormalities. She appeared lethargic, not oriented in time or place, and with nuchal rigidity. Cranial nerve testing revealed a left-sided internuclear ophthalmoplegia and a left-sided nervus abducens palsy. A tentative diagnosis of meningoencephalitis was made. Empirical treatment was initiated with high-dose amoxicillin, high-dose ceftriaxone, and high-dose aciclovir. Lumbar puncture was performed, and both culture and polymerase chain reaction were positive for Listeria monocytogenes. Antibiotic therapy was narrowed to high-dose amoxicillin. Magnetic resonance imaging showed edema within the brainstem and signs of a small abscess. The patient developed an acute kidney injury and therapy was switched to high-dose meropenem. Her neurological symptoms improved but the left internuclear ophthalmoplegia and nervus abducens palsy remained present.

CONCLUSIONS

Listeria monocytogenes Meningoencephalitis is a severe infectious disease with marked morbidity that can occur in previously immunocompetent hosts, regardless of age.