Abstract
Central nervous system involvement by Listeria monocytogenes usually presents as meningitis, meningoencephalitis or, less frequently, rhombencephalitis. Listerial brain abscesses are rare. Moreover, only 5-8% of listerial bacteremia is complicated by infective endocarditis (IE). A 70-year-old man with chronic immune thrombocytopenia (ITP) presented to our emergency department with acute onset of altered mental status and right-sided weakness. He was afebrile, with no heart murmurs or peripheral IE stigmata. Neurologic examination showed disorientation, expressive aphasia, and right-sided hemiparesis. Laboratory findings were unremarkable except for leukocytosis and hyponatremia. Brain MRI showed an irregular rim-enhancing lesion in the left frontal lobe, suspicious for a high-grade glial neoplasm. The lesion was excised, and he was started empirically on vancomycin, ceftriaxone, and metronidazole. After blood cultures grew Listeria monocytogenes, antibiotics were de-escalated to ampicillin and gentamicin. Echocardiography showed mitral valve vegetation. By Day 6, his mental status had improved. On Day 9, he was discharged to our inpatient rehabilitation center to complete six weeks on IV ampicillin and IV gentamicin. Pathology of the brain mass was subsequently reported as a listerial brain abscess. Chronic treatment with high-dose oral glucocorticoids and pre-existing ITP have been independently implicated as predisposing factors in listerial brain abscess. There is a propensity to misdiagnose listerial brain abscess as an intracranial neoplasm due to similar clinical/imaging findings. In addition, Listeria monocytogenes is an atypical cause of IE. Therefore, a high index of suspicion is necessary for early recognition and successful treatment of listerial brain abscess and listerial endocarditis in high-risk patients.
Highlights
Listeria monocytogenes is a facultatively anaerobic, non-spore-forming, gram-positive coccobacillus [1,2,3]
Listeria monocytogenes is transmitted through consumption of contaminated foods including processed/delicatessen meats, soft cheeses, pâtés, vegetables, ice creams, unpasteurized milk, raw or readyto-eat seafood, vegetables, and fruits such as cantaloupe [1,3,4]
We present the case of an elderly man with both listerial brain abscess and endocarditis - a rare finding of two uncommon manifestations of listeriosis in the same patient
Summary
Listeria monocytogenes is a facultatively anaerobic, non-spore-forming, gram-positive coccobacillus [1,2,3]. We present the case of an elderly man with both listerial brain abscess and endocarditis - a rare finding of two uncommon manifestations of listeriosis in the same patient. The patient is a 70-year-old Caucasian male resident of New York State with a history of diabetes mellitus, asthma, and chronic immune thrombocytopenia (ITP) that was refractory to medical management with high dose steroids and fostamatinib He presented with a same-day history of acute mental status change and right-sided weakness associated with a shuffling gait. CT head without contrast showed an acute space-occupying mass effect in the left frontal lobe with surrounding edema causing left-to-right midline shift (Figure 1A). A subsequent MRI of the brain with and without contrast (Figure 1B-1D) showed an acute highly irregular rim-enhancing lesion in the left frontal lobe with surrounding edema and mass effect causing left to right midline shift.
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