A case report of iatrogenic deterioration of yet undiagnosed Rhombencephalitis; always be careful with corticoids

Abstract

Background: Listeria monocytogenes is a bacterium present in some food products. It is rarely the cause of Rhombencephalitis in immunocompetent patients.

Case presentation: We report a case of an immunocompetent patient, presenting with progressive perioral numbness and dizziness. Despite treatment with antiplatelet drugs, antiviral medication, antibiotics and corticosteroids for a wide differential diagnosis, the patient deteriorated tremendously. Eventually the patient died of Listeria rhombencephalitis, most likely due to the late diagnosis and concomitant late initiation of antibiotics combined with badly timed and inappropriate corticosteroid prescription.

Conclusion: Early adequate antibiotic treatment is essential in Listeria rhombencephalitis and corticosteroid therapy should be avoided when Listeriosis is suspected.

Keywords: Corticosteroid therapy; Differential diagnosis; Listeria monocytogenes; Listeria rhombencephalitis.

Fig. 1

Timetable

Fig. 2

MRI cerebrum Fluid Attenuated Inversion Recovery (FLAIR), diffuse white matter lesions with extension into the pons and medulla oblongata

Fig. 3

MRI cerebrum (T1), diffuse hyperintensity and swelling, with enhanced ring shaped areas

Fig. 4

Microscopic findings. Hematoxylin – Eosin coloring, magnification 200x, showing mixed nuclear inflammatory infiltrates as sign of vasculitis of the entire brain with concomitant vascular destruction and trombosis

Fig. 5

Macroscopic, active vasculitis with diffuse hemorrhagic infarction from the midbrain into the cerebellum