Listeria monocytogenes meningoencephalitis in a patient with Systemic Lupus Erythematosus

Abstract

Introduction: Infectious complications are common in systemic lupus erythematosus. Although uncommon, central nervous system infections do occur and have significant lethality, with several etiological agents.

Methods: We report on the case of a 29-year-old woman recently diagnosed with systemic lupus erythematosus with hematological, cutaneous, serous and renal manifestations (class IV lupus nephritis), who underwent corticosteroid pulse therapy and mycophenolate induction therapy. After 3 months of evolution, she developed headache and altered mental status. Computed tomography showed an area of hypoattenuation in the left frontal white matter and her cerebrospinal fluid examination showed pleocytosis and hyperproteinorrhachia. Peripheral blood and CSF culture identified Listeria monocytogenes. The patient presented deterioration of her neurological status, requiring invasive mechanical ventilation, monitoring of intracranial pressure and, despite all the intensive support, persisted in a comatose state and developed multiple organ failure, evolving to death due to nosocomial bloodstream infection.

Discussion: Infection from L. monocytogenes usually occurs after eating contaminated food, manifesting itself with diarrhea and, occasionally, invasively, such as neurolisteriosis. Further investigation with CSF analysis and MRI is necessary, and the diagnosis consists of isolating the bacteria in sterile body fluid.

Conclusion: The case presents a patient whose diagnosis of meningoencephalitis became an important differential with neuropsychiatric disorder. The poor outcome reinforces the need to remember this infectious condition as a serious complication in the natural history of SLE.

Figure 1. Contrast-enhanced CT scan of the skull. Hypoattenuation area in the left frontal white matter, accentuating the expansive effect on adjacent structures, measuring about 7.0 x 5.0 cm.

Figure 2. Magnetic resonance imaging of the skull, T2 heavy echo turbo-spin technique. Expansive formation, 3.0 x 3.0 x 3.5 cm, in the left frontal lobe, affecting mainly the upper and middle frontal gyres, with irregular contours, bordered by foci of hemosiderin deposits, with an intense restriction on inside diffusion, compatible with an abscess.