title: Prolonged dysphagia due to Listeria-rhombencephalitis with brainstem abscess and acute polyradiculoneuritis.
abstract: We report a case of previously healthy student with acute rhombencephalitis and brainstem abscess caused by Listeria monocytogenes. The disease begun with uncharacteristic prodromal symptoms of gastrointestinal infection followed by headache and vertigo. After hospital admission the patient rapidly deteriorated, presenting pronounced dysphagia and respiratory failure requiring mechanical ventilation. The diagnosis was established upon clinical symptoms of infection, brainstem involvement, typical MRI findings and positive for L. monocytogenes blood culture. Infection was complicated by acute, demyelinating neuropathy, diagnosed upon clinical symptoms of frail palsy confirmed by ENG. Initially introduced empirical doxycyclin/ceftriaxon treatment was subsequently changed to targeted ampicillin/gentamycin therapy, mechanical ventilation, intravenous human immunoglobulin treatment, tracheostomy and endoscopic gastrostomy. Prolonged dysphagia resolved after rehabilitation. After one year the patient remains well with only slight dysmetria.
authors.affiliation: Infectious Diseases Department, Medical University of Gdańsk, Smoluchowskiego 18; PL-80-214 Gdańsk, Poland.
authors.forename: Tomasz
authors.initials: T
authors.lastname: Smiatacz
authors.forename: Maciej Michal
authors.initials: MM
authors.lastname: Kowalik
authors.forename: Maria
authors.initials: M
authors.lastname: Hlebowicz
mesh_terms: D000328:Adult; D000667:Ampicillin / Q000008:administration & dosage; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D001922:Brain Abscess / Q000209:etiology*; D001933:Brain Stem / Q000473:pathology; D003680:Deglutition Disorders / Q000209:etiology*; D004660:Encephalitis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D005839:Gentamicins / Q000008:administration & dosage; D006801:Humans; D008088:Listeriosis / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D008297:Male; D011129:Polyradiculoneuropathy / Q000209:etiology*; D012121:Respiration, Artificial; D012131:Respiratory Insufficiency / Q000209:etiology / Q000628:therapy; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D000667:Ampicillin