Listeria monocytogenes brain abscesses presenting as contiguous, tubular rim-enhancing lesions on Magnetic Resonance Imaging: Case series and literature review

Abstract

Listeriosis has more than a 50% mortality when the central nervous system is involved, necessitating rapid diagnosis and treatment. We present four patients with brain abscesses in the setting of diagnosed neurolisteriosis, all of which demonstrated an odd presentation of multiple small, contiguous tubular lesions with rim enhancement on magnetic resonance imaging. Our review of published cases of neurolisteriosis suggests that this may be a useful pattern to identify neurolisteriosis abscesses, allowing earlier detection and therapy.

Keywords: Listeria brain abscess; Listeria monocytogenes; Magnetic Resonance Imaging; infectious imaging sign; neurolisteriosis.

Figure 1.

Patient 1: 29-year-old male with neurolisteriosis. Axial FLAIR (a), T2 (b), T1 pre- (c) and post-contrast (d) images of the posterior fossa demonstrating an abscess comprising multiple rim-enhancing tubular lesions at the left cervicomedullary junction. Panels e and f, respectively, show sagittal DWI and T1 post-contrast images demonstrating that this tubular abscess shows restricted diffusion at the center, representing necrotic debris.

Figure 2.

Patient 2: 74-year-old female with neurolisteriosis. DWI (a) and T1 post-contrast axial (b) as well as coronal (c) T1 post-contrast images of irregular, rim-enhancing tubular lesions in the left temporal lobe, compatible with abscess.

Figure 3.

Patient 3: 27-year-old female with neurolisteriosis. DWI (a) and T1 post-contrast axial (b) as well as coronal (c) T1 post-contrast images of an irregular, rim-enhancing tubular lesion in the left frontoparietal lobe, compatible with abscess.