Neurolisteriosis: The Importance of a Prompt Diagnosis

Abstract

Immune thrombocytopenia (ITP) is a prevalent disease that may need immunosuppressant treatment, which increases the risk of an opportunistic infection. We present the case of a woman with corticosteroid-resistant ITP who was electively admitted to the hospital to initiate second-line treatment. On the second day, she presented with a high fever and altered mental status, with no lesions on the cerebral tomography and inconclusive cerebrospinal fluid analysis. Nonetheless, she was promptly started on empiric antibiotics for meningitis which were then adjusted for Listeria monocytogenes, isolated in blood culture. The cerebral magnetic resonance showed signs of cerebritis and pyogenic foci. The patient was discharged after 73 days of treatment, asymptomatic and with no neurological sequelae. The mortality rate of neurolisteriosis can be as high as 50%. The median time between the initial symptoms and their detection is seven days, with many patients already developing cerebral abscesses. The favorable outcome of this patient was due to the precocious detection and start of the treatment.

Keywords: abscess; immune thrombocytopenia; immunosuppression; listeria monocytogenes; meningoencephalitis.

Figure 1. Evolution of brain infectious lesions on cerebral magnetic resonance.

1A: Lesion (arrow) on day 3 of treatment; 1B: Lesion (arrow) on day 47 of treatment; 1C: Lesion (arrow) on day 68 of treatment.