Listeria spinal cord abscess responsive to trimethoprim-sulfamethoxazole monotherapy.
OBJECTIVE
To describe an alternative antibiotic regimen for the treatment of central nervous system Listeria monocytogenes infection.


BACKGROUND
Classical treatment of listeria infections of the brain and spinal cord has included ampicillin in combination with gentamicin and chloramphenicol. Antibiotic resistance to L. monocytogenes is extraordinarily low, and the combined risks of nephrotoxicity, ototoxicity, and agranulocytosis in an already critically ill patient make the potential use of trimethoprim-sulfamethoxazole monotherapy for coverage or treatment of listeria an important alternative.


METHODS
Case report.


RESULTS
A 58-year-old woman presented with a two-week history of progressive quadriplegia. Gadolinium enhanced MRI showed diffuse edema of the cervical and thoracic spine with ring-enhancing lesions. Cerebrospinal fluid and blood cultures both grew L. monocytogenes. Spinal cord biopsy of the lesion revealed inflammation with necrosis and also grew listeria. Intravenous trimethoprim-sulfamethoxazole (8 mg/kg in four divided doses) was administered for six weeks with resultant arrest of neurological symptoms and stabilization of the clinical course. Although the patient was quadraparetic she was able to be discharged to a rehabilitation facility.


CONCLUSIONS
Trimethoprim-sulfamethoxazole monotherapy may be a potential alternative option for critically ill patients with central nervous system L. monocytogenes infection.
Rossi
F H
FH
Department of Neurology, University of Florida, Gainesville, USA.
White
J
J
Quisling
R
R
Triggs
W J
WJ
Okun
M S
MS
D000890:Anti-Infective Agents / Q000627:therapeutic use; D002574:Cervical Vertebrae / Q000473:pathology; D020802:Epidural Abscess / Q000175:diagnosis / Q000188:drug therapy*; D005260:Female; D006801:Humans; D008584:Meningitis, Listeria / Q000175:diagnosis / Q000188:drug therapy*; D008875:Middle Aged; D013116:Spinal Cord / Q000473:pathology*; D013904:Thoracic Vertebrae / Q000473:pathology; D015662:Trimethoprim, Sulfamethoxazole Drug Combination / Q000627:therapeutic use*
D000890:Anti-Infective Agents; D015662:Trimethoprim, Sulfamethoxazole Drug Combination