Listeria monocytogenes septicemia and meningitis induced from immunosuppressant treatments in a patient with neuromyelitis optica spectrum disorder: A case report

Abstract

Introduction: The aim of this study is to report a fatal case of Listeria monocytogenes septicemia and meningitis complicating azathioprine and glucocorticosteroid treatments during an acute flare of neuromyelitis optica spectrum disorder (NMOSD). Case Report: A Chinese woman who was diagnosed with NMOSD had been on oral prednisolone and azathioprine for about three years. After her fourth relapse, she was treated with high-dose glucocorticosteroids again, and she soon developed an impaired consciousness, headache, and neck stiffness. Her blood culture was positive for L. monocytogenes, and a head computed tomography showed severe hydrocephalus. Although shunt surgery was performed and antibiotics were used, the patient continued to decline and eventually died. Conclusion: We reported the first Asian case of azathioprine-associated L. monocytogenes septicemia in a patient with NMOSD. Physicians should be aware of this serious and potentially lethal side effect when adding multiple immunosuppressants to the regimen of a patient who is already immunocompromised.