Rombo encephalitis and cerebellar abscess due to Listeria monocytogenes with fulminant course in an immunocompetent elderly patient: A case report

Abstract

Listeria Monocytogenes (LM) is an opportunistic bacterium that can cause from mild infections to severe clinical pictures with neurological involvement, being responsible for sporadic cases, epidemic outbreaks and a high mortality and case fatality rate. Neurolisteriosis may present as meningitis, meningoencephalitis, rhomboencephalitis or brain abscesses. LM rhomboencephalitis is a rare disease for which advanced age and cellular immunosuppression are common risk factors, although it may occur in patients without prior immunosuppression. Spread to the CNS occurs haematogenously through the blood-brain barrier, by direct invasion or by retrograde brain migration through nerve tracts. Different diagnostic subtyping methods are available, although DNA sequencing is the technique of choice for epidemiological studies. The combination of ampicillin with gentamicin for 6-8 weeks is usually the recommended treatment, and neurosurgery may improve the prognosis in patients with brain abscess, although there are no clinical practice guidelines available with a high level of evidence. The diagnosis of LM rhomboencephalitis should be suspected in any patient with an infectious condition with evidence of meningeal or brainstem involvement. Mortality from neurolisteriosis is increasing in Europe due to the ageing population and the increase in immunocompromised patients, and can reach up to 51%. The case described in this article is exceptional, presenting acute rhomboencephalitis with cerebellar abscesses in a healthy patient with no risk factors and a fulminant course.