P069 Listeria monocytogenes bacteremia in a pregnant ulcerative colitis patient treated with adalimumab and azathioprine

Abstract

BACKGROUND: Listeria monocytogenes is an aerobic gram-positive intracellular bacillus, often foodborne and found elsewhere. Although it is an uncommon cause of illness in the general population, it is an important cause of severe infection in neonates, pregnant women, elderly and immunosuppressed patients. Invasive listeriosis, meningitis and meningoencephalitis, bacteremia with or without joint, eye or heart focalization are clinical manifestations of the disease. Maternal listeriosis may develop intrauterine infection of fetus which can lead to severe complications such as amnionitis, preterm labor, spontaneous abortion, stillbirth and neonatal sepsis. Anti-TNF therapy has changed treatment paradigm of inflammatory bowel disease for decades. TNF-α acts as a mediator of local inflammation to contain infection and is crucial in host's response against various microorganisms, particularly intracellular agents like Mycobacterium and Listeria monocytogenes. We report a case of Listeria monocytogenes bacteremia in pregnant ulcerative colitis (UC) patient treated with adalimumab and azathioprine. CASE: A 33-year-old pregnant UC patient was hospitalized with high fever after a trip to China. She is at 17 weeks pregnant and being treated with adalimumab and azathioprine for 2 years. The colonoscopy was performed at 6 months before and showed mucosal healing of large intestine. She is currently in clinical remission despite fever. Laboratory finding shows leukocytosis (18,000/mm3), mild anemia (11.2 g/dL) and high CRP (12.5 mg/L). Listeria monocytogenes was identified with her blood culture, and the ampicillin was administered immediately. We decided to stop adalimumab and azathioprine until delivery because of concerns that anti-TNF can go through placenta and may cause an intrauterine infection. After antibiotics were administered to her for 2 weeks, her infection was treated and laboratory findings were normalized. She is currently undergoing routine antenatal visits to the obstetrician, has no evidence of intrauterine infection, and still maintains clinical remission. DISCUSSION: We report the first case of Listeria monocytogenes bacteremia in a pregnant UC woman receiving adalimumab and azathioprine. We hope that the treatment policy for discontinuation and re-administration of biological agents will be established in this case in the future.