Abstract
Listerial brain abscesses are rare, and are found mostly in patients with underlying hematological malignancies or solid-organ transplants. A case of a patient with Crohn's disease and multiple brain abscesses involving the left cerebellum and right sylvian fissure is described. The Gram stain and histopathology of the cerebellar abscess revealed Gram-positive, beaded rods suggestive of Nocardia. However, on culture, Listeria monocytogenes was identified. Listeria may appear Gram-variable and has been misidentified as streptococci, enterococci and diphtheroids. The present case is the first reported case of L monocytogenes resembling Nocardia on both microbiological and histopathological assessment. Reported cases of listerial brain abscesses are sporadic, while the current case was part of a nationwide listerial outbreak linked to consumption of contaminated deli meats. Broad antimicrobial therapy (including antilisterial coverage) in immunosuppressed patients presenting with brain abscess is crucial, until cultures confirm the identification of the organism.
Highlights
L’acquisition nosocomiale potentielle de Listeria monocytogenes épidémique se manifestant par des abcès cérébraux multiples évocateur d’une nocardiose
There have only been a few nosocomial outbreaks reported: in Costa Rica, infants were bathed with mineral oil contaminated with L monocytogenes [6], and in the United States, a large multistate outbreak of listeriosis due to contaminated deli meats occurred, in which 18% of outbreak patients may have been served contaminated meat in health care institutions [7]
L monocytogenes is more commonly implicated as a serious infectious agent in patient populations with impaired cell-mediated immunity such as pregnant women, organ transplant recipients and the elderly
Summary
L’acquisition nosocomiale potentielle de Listeria monocytogenes épidémique se manifestant par des abcès cérébraux multiples évocateur d’une nocardiose. L monocytogenes is more commonly implicated as a serious infectious agent in patient populations with impaired cell-mediated immunity such as pregnant women, organ transplant recipients and the elderly. Magnetic resonance imaging later confirmed these findings, in addition to the presence of tiny satellite lesions with adjacent edema, mostly seen in the right sylvian fissure region (Figure 2).
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