A rare cause of brainstem encephalitis in an immunocompetent young patient: Case report and review

Abstract

BackgroundSome of the pathogens have a high affinity for the central nervous system. Here, we describe a rare case of encephalomyelitis in a healthy woman misdiagnosed. Case presentationAn 18-year-old woman without medical history presented with headache, vertigo, and high fever. Case reportNeurological examination revealed vertical nystagmus, right 3rd cranial nerve palsy, and moderate weakness. Non-contrast brain CT was normal. The lumbar puncture revealed only mild pleocytosis. So that, we diagnosed a viral meningoencephalitis. We started the empiric antibiotic treatment. Brain MRI demonstrated multiple ring-enhancing lesions. Therefore, we empirically initiated pulse dose steroid treatment for any demyelinating pathology. After the steroid treatment, the patient's status got worse. Listeria monocytogenes was isolated on blood culture. We stopped the treatment; and immediately started ampicillin, meropenem, and gentamicin combination. The patient's status improved gradually. ConclusionsBecause of highly variable laboratory findings and the disease course, listeria rhombencephalitis is usually misdiagnosed by clinicians. Early diagnosis and adequate antibacterial treatment can decrease the morbidity and mortality of this pathogen.