Listeria monocytogenes Ankle Osteomyelitis in a Patient with Rheumatoid Arthritis on Adalimumab: A Report and Literature Review of Listeria monocytogenes Osteomyelitis

Abstract

Localized Listeria infection predominantly occurs in the prosthetic and hip joints. We herein report a case of Listeria monocytogenes ankle osteomyelitis in a 73-year-old man receiving adalimumab who was transferred to our hospital because of suspected rheumatoid arthritis (RA) flare. He reported a four-month history of left ankle swelling. A surgical biopsy revealed L. monocytogenes osteomyelitis in the left tibia and talus bones. The patient was successfully treated with antibiotics and surgical debridement. Thus, infection due to L. monocytogenes can present as ankle osteomyelitis in immunocompromised patients and may mimic an RA flare.

Keywords: Listeria monocytogenes, osteomyelitis; adalimumab; rheumatoid arthritis; tumor necrosis factor (TNF)-alpha inhibitor.

Figure 1.

(A) X-ray findings show granulation around the ankle joint (white arrowheads). (B) MRI findings show a decreased T1 signal in the tibia and talus (white arrows) and granulation (white arrowheads). (C) MRI findings further show an increased fat-suppressed T2 signal in the tibia and talus (white arrows) and granulation (white arrowheads). MRI: magnetic resonance imaging

Figure 2.

Pathological images of the synovial membrane (A) (×40) and (B) (×200) show neutrophilic infiltration without caseating necrosis.

Figure 3.

X-ray findings show surgical resection of the affected bone and cement fixation (white arrowheads) in the (A) lateral view and (B) posterior to anterior view.