Listeria monocytogenes meningitis in systemic lupus erythematosus patients

Abstract

Objective To summarize the clinical characteristics of SLE patients complicated with Listeria monocytogenes meningitis (LMM). Methods The clinical manifestations, systemic involvements, laboratory tests, cerebrospinal fluid (CSF) examinations, treatment and prognosis of SLE inpatients combined with LMM in Peking Union Medical College Hospital during Janurary 2000 to December 2015 were retros-pectively analyzed. Results Eight SLE patients with LMM accounted for 0.14% of the 5 675 hospitalized SLE patients. Seven were female and 1 was male, with the mean age of (35±16) year. Headache (7/8) was the most common neurological symptom followed by positive meningeal irritation sign (5/8), unconsciousness (3/8) and nausea or vomiting (2/8). Increased intracranial pressure was found in 7 cases and 4 of them were even higher than 330 mmH2O. CSF protein elevated in 6 cases and CSF glucose decreased in 6 cases. LMM often occurred in inactive or mild active SLE with the average SLE disease activity index (SLEDAI) score of 4.7 ± 1.5. Systemic manifestations included hematologic changes (6/8), rashes (4/8), renal involvement (4/8) and arthritis (3/8), etc. Treated by antibiotics such as penicillin and medications for SLE, 7 patients achieved clinical improvements, 1 patient died. Conclusion LMM is one of the opportunistic infections in SLE patients and tends to occur in inactive lupus cases. There are unspecific clinical and laboratory features and CSF changes which maybe overlap and mix up with systemic manifestations of SLE. That's why it is necessary to take continuous cultures of CSF. Early identification and appropriate treatment lead to prognostic improvement of these patients. Key words: Lupus erythematosus, systemic; Meningitis, Listeria; Headache; Intracranial pressure