Bell's palsy as the initial manifestation of Listeria monocytogenes rhombencephalitis with brainstem abscesses in an immunocompetent adult: a case report.

Listeria monocytogenes (LM) rhombencephalitis is a rare but severe manifestation of neurolisteriosis, typically reported in immunocompromised or elderly patients and often associated with high morbidity and mortality. We describe a 66-year-old immunocompetent man who presented initially with peripheral facial paralysis, an uncommon early manifestation reflecting cranial neuritis, before rapidly developing brainstem dysfunction, respiratory failure, and multiple abscesses. Diagnosis was confirmed by cerebrospinal fluid (CSF) multiplex polymerase chain reaction (PCR) and blood cultures, and despite targeted antimicrobial therapy the patient developed severe neurological sequelae. This case underscores that cranial neuritis may present as an early clue of neurolisteriosis.