Postpartum Listeria Meningitis: A Case Report (P2-10.006)

Abstract

<h3>Objective:</h3> n/a <h3>Background:</h3> Acute bacterial meningitis is a neurological emergency and fatal if left untreated. Here we present a case of bacterial meningitis, highlighting postpartum listeria monocytogenes infection. <h3>Design/Methods:</h3> <h3>Description:</h3> We present a case of 27 years-old woman with past medical history of migraine and hyperthyroidism, brought to the hospital with acute onset of reduced level of consciousness. A day prior to presentation, she woke up with a severe retro-orbital headache of 10/10 intensity along with nausea, vomiting, photophobia and phonophobia. Her symptoms further progressed to worsening confusion/somnolence with agitation. She had an uncomplicated vaginal delivery a month earlier. On admission, vitals were significant for high grade fever, hypotension, tachypnea and tachycardia. On examination, she was restless, combative, was not following any commands. No focal motor deficit. Nuchal rigidity and Babinski were negative. Labs showed mild anemia, leukocytosis, mild hyponatremia and lactic acidosis. MRI Brain showed faint diffuse leptomeningeal enhancement. CSF analysis showed WBC 732/Ul, SEG: 66%, protein&gt; 300mg/dl and CSF glucose &lt;20mg/dl. Meningitis panel and CSF culture were positive for listeria monocytogenes. Post CSF analysis, her broad spectrum antibiotics were deescalated to ampicillin for 21 days and gentamycin for 7 days for synergistic effects. During the initial treatment phase, she developed horizontal binocular diplopia and her exam showed isolated sixth nerve palsy. MRI brain revealed worsening diffuse leptomeningitis, involving the basal cisterns and the ependymal walls of the lateral ventricles. Eventually, she responded to the treatment and her symptoms resolved slowly. <h3>Results:</h3> n/a <h3>Conclusions:</h3> Listeria Monocytogenes can be a possible cause of postpartum meningoencephalitis due to the underlying transient immunosuppressive condition. Return to a normal immune response may take as long as up to one year after childbirth. Treatment should not be delayed in highly suspicion cases to avoid complications like rhombencephalitis, progressive neurological deficits and eventually death. <b>Disclosure:</b> Mr. Tang has nothing to disclose. Dr. Kausar has nothing to disclose. Dr. Rivera has nothing to disclose. The institution of Dr. Cruz-Flores has received research support from University of Texas System. Dr. Yerram has nothing to disclose.